Zanubrutinib-Induced Acneiform Rash in a Patient With Waldenstrom's Macroglobulinemia

Area of Science:

• Hematology
• Dermatology
• Pharmacology

Background:

• Waldenström's macroglobulinemia is a rare lymphoproliferative disorder.
• Bruton's Tyrosine Kinase inhibitors (BTKi) are an effective treatment option.
• Zanubrutinib, a newer BTKi, has fewer off-target effects but can cause dermatologic toxicities.

Purpose of the Study:

• To report a case of acneiform rash in a patient with Waldenström's macroglobulinemia treated with zanubrutinib.
• To highlight the potential for cutaneous side effects with newer BTKi.
• To emphasize the importance of prompt diagnosis and management of drug-induced rashes.

Main Methods:

• Case report of an 81-year-old male with Waldenström's macroglobulinemia.
• Observation of a Grade I acneiform rash after initiating zanubrutinib.
• Treatment with topical agents and oral antibiotics.
• Histological examination of the rash.
• Assessment using the Naranjo score for adverse drug reactions.

Main Results:

• The patient developed a folliculocentric acneiform eruption on the face and trunk.
• The rash resolved with topical azelaic acid, salicylic acid, and oral azithromycin.
• Histology revealed a CD3+ T-cell infiltrate without epidermotropism.
• A Naranjo score of 8 indicated a probable drug reaction.

Conclusions:

• Cutaneous side effects, such as acneiform rash, can occur with zanubrutinib treatment.
• Awareness of these dermatologic toxicities is essential for clinicians.
• Timely diagnosis and appropriate management can optimize patient care for Waldenström's macroglobulinemia patients on BTKi therapy.