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Blistering and Skin Fragility Due to Imatinib Therapy: Loss of Laminin and Collagen IV as a Possible Cause of Cutaneous Basement Membrane Instability
- Source :
- The American Journal of Dermatopathology. 40:371-374
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- Imatinib mesylate (Glivec; Novartis AG, Basel, Switzerland) is a tyrosine kinase inhibitor which is used in the treatment of oncologic diseases like chronic myeloid leukemia and gastrointestinal stroma tumor (GIST). Among cutaneous side effects, bullous reactions are rare. The authors describe the case of a 66-year-old woman developing blistering and skin fragility on her hands, foot, lower legs, and back after intake of imatinib for treatment of GIST. Biopsy showed vacuolar alteration at the dermoepidermal junction (DEJ) associated with a few lymphocytes and a subepidermal blister. The upper papillary dermis below the vacuolar alteration and below the blister showed hyalinization and loss of elastic microfibrils. Direct immunofluorescence was negative for deposits of immunoglobulins. Immunofluorescence on cryosections revealed loss of laminin and collagen IV in vacuoles at the DEJ. Electron microscopy showed dissolution of lamina lucida and lamina densa of the basement membrane below as well as next to the vacuoles and blister. In conclusion, the authors present the first patient with GIST with blistering and skin fragility due to imatinib therapy. As a pathophysiological explanation the authors propose loss of laminin and collagen IV at the DEJ leading to basement membrane instability and blistering. This case also suggests additional features reminiscent of lichen sclerosus induced by imatinib, a drug which is actually known for its antifibrotic effects.
- Subjects :
- Collagen Type IV
Pathology
medicine.medical_specialty
Gastrointestinal Stromal Tumors
Antineoplastic Agents
Dermatology
Basement Membrane
Pathology and Forensic Medicine
030207 dermatology & venereal diseases
03 medical and health sciences
Blister
0302 clinical medicine
Laminin
medicine
Humans
skin and connective tissue diseases
Aged
Skin
Dermoepidermal junction
Basement membrane
integumentary system
biology
business.industry
Papillary dermis
Imatinib
General Medicine
Lamina lucida
medicine.anatomical_structure
Imatinib mesylate
030220 oncology & carcinogenesis
Imatinib Mesylate
biology.protein
Female
Lamina densa
business
medicine.drug
Subjects
Details
- ISSN :
- 01931091
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- The American Journal of Dermatopathology
- Accession number :
- edsair.doi.dedup.....3e1ba9d2b69e2f66731d7344bc1557a6