Dasatinib-Induced Cervicofacial Edema in Chronic Myeloid Leukemia in Blast Crisis
Dasatinib is a second-generation BCR::ABL1 tyrosine kinase inhibitor widely used for chronic myeloid leukemia (CML). Although pleural effusion and fluid retention are recognized toxicities, cervicofacial edema is an exceptionally rare adverse event that may mimic severe infection, particularly in neutropenic patients. We describe a patient with CML in blast crisis who developed dasatinib-induced cervicofacial edema during induction chemotherapy.
Materials and Methods/Case Presentation/Objective:
Clinical, laboratory, radiologic, microbiologic, treatment, and follow-up data were retrospectively reviewed. Alternative causes of edema, including deep neck space infection, cellulitis, generalized fluid overload, and cardiac disease, were assessed using clinical findings, computed tomography (CT), blood cultures, and echocardiography.
Results: A man in his forties with newly diagnosed myeloid blast-phase CML received cytarabine, doxorubicin, and dasatinib. On day 13, during profound febrile neutropenia (absolute neutrophil count 200/μL), he developed rapidly progressive bilateral periorbital, facial, and neck swelling with dysphagia. CT showed diffuse cervicofacial, periorbital, submandibular, and parotid edema without abscess or thrombosis. Blood cultures remained negative, and echocardiography demonstrated preserved systolic function. Dasatinib was withheld, piperacillin-tazobactam was continued for febrile neutropenia, and intravenous hydrocortisone was started. Marked improvement occurred within 48 hours despite persistent neutropenia, with complete resolution before neutrophil recovery, supporting a drug-related etiology.
Results/Description/Main Outcome Measure(s): The patient achieved morphologic remission after induction and later tolerated reduced-dose dasatinib during consolidation without recurrence.
Conclusion(s).:
Dasatinib-induced cervicofacial edema is a rare but important diagnostic consideration in neutropenic patients presenting with acute facial swelling. Prompt recognition, exclusion of infection, temporary drug interruption, and corticosteroid therapy can achieve rapid resolution. Rechallenge at a lower dose may be feasible in carefully selected patients when continued dasatinib therapy is clinically indicated.
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