Black Mouth (Discolouration of palate) Glivec

Dear Sue, Anjana (Asian CML Support Group) has kindly given me some links and ideas to the possible causes of the discolouration and mouth ulcers you describe.
See below for her comments.

Hope this is of some help.

Sandy

Lichenoid eruption is a skin eruption that can occur rarely with Gleevec. There is quite a bit of literature on it. It is a skin reaction to the drug and can affect any part of the body including mouth and tongue. From photos of lichen planus, the tongue can be blue black in color.

As for mouth ulcers, that can be a side-effect of Gleevec, see the link from Mayo Clinic.
However, you need to ask if the patient has low counts since some patients with low counts can have mouth ulcers.

1. ...link to mayo clinic for info on mouth ulcers

2. Ann Dermatol Venereol. 2004 Jun-Jul;131(6-7 Pt 1):571-3.
[Lichenoid cutaneous reaction to imatinib]
[Article in French]

Roux C, Boisseau-Garsaud AM, Saint-Cyr I, Hélénon R, Quist D, Delaunay C.

Service de Dermatologie et Vénéréologie, CHU La Meynard, Hôpital Pierre Zobda Quitman, Fort-de-France, Martinique.

INTRODUCTION: Imatinib (Glivec) is a new therapeutic molecule used for the treatment of chronic myeloid leukemia. Cutaneous side effects with this treatment are common but lichenoid drug eruption is exceptional. We report the first case with profuse cutaneous lichen. CASE REPORT: A 52 year-old woman presented with a 5-year history of chronic myeloid leukemia. The different chemotherapies had failed (persisting polyadenopathies and splenomegalia). She was treated with imatinib (400 mg/day). Two months after the beginning of this treatment a disseminated cutaneous eruption appeared on the trunk, legs, arms and face without mucosal involvement and composed of dark purple, prurigenous, papules suggestive of lichen planus. The cutaneous biopsy confirmed the diagnosis of lichen planus. Suspension of the drug led to the complete regression of the eruption, without any other local treatment, within 2 months. Reintroduction of the drug led to the recurrence of the lesions. DISCUSSION: Cutaneous reactions to imatinib are common and occur in 11 to 67 p. 100 of patients depending on the series. More severe cutaneous reactions have been described: exfoliating dermatites, generalized pustulosis, epidermal necrolysis. The aspect of profuse lichenoid eruption of the skin and the correlation with cutaneous lesions clinically and histologically evocative of lichen planus has not been described other than an isolated buccal involvement in a 72 year-old woman. In our patient, study of the imputability criteria is in favor of imatinib's responsibility.

3. ...case presentation on dermatological effect of imatinib

4. Case Report

Oral Lichenoid Reaction to Imatinib (STI 571, Gleevec)
Davin S. Lim, James Muir

Department of Dermatology, Mater Hospital, Brisbane, Qld., Australia

Address of Corresponding Author

Dermatology 2002;205:169-171 (DOI: 10.1159/000063899)

* Imatinib
* Oral lichenoid drug reaction
* Chronic myeloid leukaemia

Imatinib or STI 571 is a phenylaminopyrimidine derivative and a member of a new class of drugs known as signal transduction inhibitors. These compounds specifically inhibit the proliferation of v-abl- and bcr-abl-expressing cells and have recently been approved as treatment for chronic myeloid leukaemia (CML). Results have been promising, and imatinib may well be the best single agent for the treatment of CML in the near future. Here we report an erosive oral lichenoid eruption confined to the buccal mucosa and dorsum of the tongue which appeared 12 weeks after commencement of imatinib in a 72-year-old woman with CML. The histology was consistent with a lichenoid drug eruption. The lesions resolved upon withdrawal of the drug. To our knowledge, this is the first reported lichenoid reaction to imatinib, and in the setting of CML it must be differentiated from idiopathic lichen planus, paraneoplastic pemphigus and graft-versus-host disease.