SHM Converge Scientific Abstract ePoster Gallery-Rash Decisions: A Case of Ibrutinib Associated Extensive Grover Disease Like Eruption in a Patient With Chronic Lymphocytic Leukemia

Rash Decisions: A Case of Ibrutinib Associated Extensive Grover Disease Like Eruption in a Patient With Chronic Lymphocytic Leukemia

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This case report describes an 81-year-old woman with chronic lymphocytic leukemia/small lymphocytic lymphoma who developed a diffuse, intensely pruritic, erythematous papular rash 5–6 months after starting ibrutinib. Because the eruption initially raised concern for either cutaneous involvement of her leukemia or an adverse drug reaction, ibrutinib was temporarily discontinued. The rash improved somewhat, but pruritus persisted.<br /><br />A punch biopsy was performed and showed focal basal keratinocyte necrosis and epidermal detachment. After review by two dermatopathologists, the findings were consistent with acantholytic dyskeratosis, supporting a diagnosis of Grover disease (transient acantholytic dermatosis). Although her rash later recurred even without restarting ibrutinib, treatment with topical triamcinolone significantly improved her symptoms.<br /><br />The report reviews Grover disease as a rare, usually transient, pruritic vesiculobullous disorder that most often affects older men and classically involves the trunk. It is associated with heat, sweating, hospitalization, malignancy, and certain medications. Extensive or atypical cases may involve areas beyond the trunk and can be linked to hematologic or solid tumors. The exact mechanism is unclear, but proposed explanations include paraneoplastic effects or drug-related factors.<br /><br />The authors note that ibrutinib is known to cause cutaneous reactions, with prior studies reporting rash in 15–28% of patients, usually mild and self-limited. However, this case may represent the first documented association between a Bruton's tyrosine kinase inhibitor and Grover disease-like eruption. The case highlights the importance of considering Grover disease in patients with cancer who develop pruritic rashes during targeted therapy, and it emphasizes biopsy confirmation and symptom-directed treatment.

Asset Subtitle

Alphonso Wilson

Meta Tag

Author List Alphonso Wilson, Bhardawaj Satyavolu, Priya Patel, Touqir Zahra MD, Vinodhini Arjunan

Category Clinical Vignettes

Concept Grover Disease

Concept Skin Biopsy

Concept Ibrutinib

Concept Acantholysis

Concept Dermatopathology

Distinguished Non-Finalist

Presenter Organization Florida Atlantic University

Presenting Author Alphonso Wilson

Track Adult

Keywords

Grover disease

transient acantholytic dermatosis

ibrutinib

chronic lymphocytic leukemia

small lymphocytic lymphoma

pruritic rash

acantholytic dyskeratosis

cutaneous adverse reaction

dermatopathology

topical triamcinolone

Grover Disease

Skin Biopsy

Ibrutinib

Acantholysis

Dermatopathology