# Ibrutinib-Induced Perianal Rash Complicated by Bacterial Infection in a Patient With Chronic Lymphocytic Leukemia: A Case Report and Literature Review

## TL;DR

A patient with chronic lymphocytic leukemia developed a severe perianal rash from ibrutinib, worsened by a bacterial infection, highlighting a rare side effect.

## Contribution

This is the first reported case of perianal rash caused by ibrutinib complicated by bacterial infection.

## Key findings

- Ibrutinib therapy can cause perianal skin toxicity.
- Bacterial infection can exacerbate ibrutinib-induced rashes.
- Discontinuation of ibrutinib and antibiotics improved the patient's condition.

## Abstract

Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, is widely used in the treatment of chronic lymphocytic leukemia (CLL). However, its use is associated with a range of adverse effects, including cutaneous manifestations. We present a case of a 74-year-old male with CLL who developed a perianal rash following four years of ibrutinib therapy. The rash progressively worsened due to a superimposed bacterial infection, resulting in perianal cellulitis with bleeding, severe pain, and difficulty passing stools. The patient was started on antibiotics, and ibrutinib was discontinued. This case highlights an unusual presentation of ibrutinib-induced skin toxicity in the perianal region, complicated by bacterial infection, and underscores the importance of early recognition and management. To the best of our knowledge, this is the first report of such a manifestation, contributing new insights into the spectrum of ibrutinib-associated cutaneous adverse effects.