Bortezomib

Abstract

Stevens-Johnson syndrome : case report A 71-year-old woman developed Stevens-Johnson syndrome (SJS) during treatment with bortezomib for multiple myeloma. The woman from South-Korea, with multiple myeloma had been receiving chemotherapy consisting of subcutaneous bortezomib [Velcade] 1.9mg (1.3 mg/m2) injection on days 1, 4, 8, and 11, plus melphalan, prednisone and prednisolone. She also received amlodipine/telmisartan for hypertension. Aciclovir, levofloxacin, cotrimoxazole [trimethoprim/sulfamethoxazole] and fluconazole were used as prophylaxis with the chemotherapy, while allopurinol was taken to prevent tumor lysis syndrome. However, she presented with a skin eruption that had developed during the course of chemotherapy. The day after the third bortezomib injection on day 8, a high fever was noted. Thus, the woman was treated with piperacillin/sulbactam. After 3 days, the antibiotic regimen was changed to doripenem and vancomycin because the fever remained uncontrolled. However, the fever persisted and a skin rash developed on neck and trunk 2 days after the antibiotic switch. Hence, she was clinically diagnosed with a drug eruption induced by the antibiotics, which were then discontinued. Two days after the antibiotics were discontinued, she complained of severe eye pain with conjunctival hyperemia, oral pain and a body-wide skin rash. An ophthalmologic evaluation, severe corneal ulceration with conjunctival injection was observed. Erosive lesions in the oral mucosa and laryngeal ulceration were detected on an ear, nose, and throat examination. Skin blistering was observed on the anterior chest. She was diagnosed with SJS and all medications were stopped. Then, she was treated with systemic methylprednisolone, immune-globulin and dexamethasone/levofloxacin eye drops. She remained haemodynamically stable and did not develop multiorgan failure. Thereafter, the cutaneous rash and eye and oropharyngeal involvement gradually improved. Two weeks after recovery, the patch test was performed using drugs received by her, including bortezomib, to identify the causal drug. The patch test revealed a positive reaction to bortezomib. Thus, she was diagnosed with bortezomib-induced SJS. The initial diagnosis of drug eruption induced by the antibiotics was ruled out. Subsequently, her chemotherapy was changed to lenalidomide. Other medications were also administered, but no adverse events were reported.