LAUSR

A 60yearold man without any comorbidities was diagnosed with chronic phase chronic myeloid leukaemia (Sokal lowrisk) in October 2020. He was started on oral imatinib 400 mg once a day, with which he achieved a deep molecular response (DMR) at 1 year. In November 2021, he complained of the acute onset of white patches over his body, which had become confluent, progressed rapidly and involved the entire body within 2 weeks. History was negative for any other drug intake, autoimmune disease, loss of appetite or weight, or family history of skin diseases. On examination, there were diffuse vitiligolike skin lesions distributed over the entire body including scalp, face, hands, feet and trunk (images). Examination was otherwise normal. Antinuclear antibody, thyroid function tests, serum cortisol and computed tomography of chest and abdomen were normal. The possibility of imatinibinduced vitiligo was considered. Since, the patient had completed only 1 year of treatment, he was not eligible for an imatinib discontinuation trial. Considering his DMR, the imatinib dose was reduced to 300 mg once a day in November 2021. After 2 months of lowdose imatinib, there was no progression of vitiligo, although, lesions were still persistent. He was referred to the dermatology clinic for the initiation of vitiligospecific treatment. Although, imatinib has been associated with a number of mucocutaneous adverse effects including, both hypoand hyperpigmentation, extensive vitiligo secondary to its use has been reported only rarely.1,2 The mechanism of these skin pigmentary changes is unclear, although inhibition of the KIT receptor on melanocytes resulting in melanocyte apoptosis has been proposed.1,2 Acute onset of extensive vitiligo in an elderly man without any underlying autoimmune disease, developing after starting imatinib and stabilizing after dose reduction favours the diagnosis of druginduced vitiligo over coincidental de novo vitiligo in this case.