Han Joseph, Owji Shayan, Agarwal Aneesh, Kamat Samir, Luu Yen, Mubasher Adnan, Niedt George, Ray Chloe, Cho Hearn Jay, Gulati Nicholas, Lamb Angela
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
Dermatopathology (Basel). 2023 Jul 21;10(3):226-230. doi: 10.3390/dermatopathology10030031.
Bortezomib is the first proteasome inhibitor to treat a variety of malignancies and is currently part of the standard of care regimen for the initial treatment of patients with newly diagnosed multiple myeloma. While bortezomib is generally well tolerated, it has been associated with various side effects, which have limited its use in some patients. Here, we describe a unique case with histological confirmation of a reticular eruption that appeared at the site of a subcutaneous administration of bortezomib in a 62-year-old male who was newly diagnosed with IgG kappa multiple myeloma. A skin biopsy was performed, which revealed superficial perivascular dermatitis predominantly composed of lymphocytes with rare eosinophils. The patient was successfully treated with betamethasone dipropionate 0.05% cream. When consulted, dermatologists should advise the oncology team of multiple myeloma patients treated with bortezomib to maintain a high threshold before discontinuing the drug when a patient experiences an atypical, reticular rash following subcutaneous administration. Additionally, potent topical corticosteroids, such as betamethasone dipropionate 0.05% cream, should be considered in managing the cutaneous reticular eruptions related to bortezomib administration, in order to maintain an optimal treatment regimen for patients with multiple myeloma.
硼替佐米是首个用于治疗多种恶性肿瘤的蛋白酶体抑制剂，目前是新诊断的多发性骨髓瘤患者初始治疗标准护理方案的一部分。虽然硼替佐米总体耐受性良好，但它与多种副作用相关，这限制了其在一些患者中的使用。在此，我们描述了一例独特病例，一名62岁新诊断为IgG κ型多发性骨髓瘤的男性患者，在皮下注射硼替佐米的部位出现了经组织学证实的网状皮疹。进行了皮肤活检，结果显示为浅表性血管周围皮炎，主要由淋巴细胞组成，伴有罕见的嗜酸性粒细胞。该患者使用0.05%丙酸倍他米松乳膏成功治愈。咨询皮肤科医生时，对于接受硼替佐米治疗的多发性骨髓瘤患者，当患者在皮下给药后出现非典型网状皮疹时，肿瘤学团队在停药前应保持较高的阈值。此外，在处理与硼替佐米给药相关的皮肤网状皮疹时，应考虑使用强效外用皮质类固醇，如0.05%丙酸倍他米松乳膏，以便为多发性骨髓瘤患者维持最佳治疗方案。
