A case of bortezomib-associated cutaneous lymphocytic vasculitis

Bortezomib (Velcade®) is a newly developed chemotherapeutic agent that is mainly used for the treatment of multiple myeloma. It is a selective and reversible inhibitor of proteasome, which is a multicatalytic enzyme complex found in the cytoplasm of all eukaryotic cells. Its therapeutic target is nuclear factor-kappa B (NF-.B), which is a kind of transcription factor. Bortezomib blocks inhibitory .B protein degradation, it prevents NF-.B activation and it induces apoptosis in multiple myeloma cells. Its side effects are known to be fatigue, gastrointestinal symptoms, thrombocytopenia and peripheral neuropathy. However, little is known about its cutaneous adverse effects. A 76 year-old patient with multiple myeloma had been treated with MP (melphalan and prednisone) chemotherapy, but the treatment was not effective. Therefore, the chemotherapeutic regimen was changed to bortezomib only. Two days after the first administration of bortezomib, multiple erythematous papules and purpuric patches on the trunk and both extremities developed. The cutaneous symptoms improved after the discontinuation of bortezomib. However, the skin lesion was aggravated during the 2nd bortezomib chemotherapeutic cycle and new erythematous papules developed on his face during the 3rd bortezomib chemotherapeutic cycle. The histopathologic finding showed predominant lymphocytic infiltration with some eosinophils around the vessel walls in combination with red blood cell extravasation. Herein, we report on a 76-year-old male patient with multiple myeloma and who developed cutaneous vasculitis after the administration of bortezomib.