A Rare Case of Ixazomib-Induced Cutaneous Necrotizing Vasculitis in a Patient with Relapsed Myeloma

Ixazomib is the only oral proteasome inhibitor used in relapsed/refractory myeloma. Cutaneous side effects due to ixazomib have been documented in the literature; however, cutaneous necrotizing vasculitis is extremely rare. We describe a case of a 74-year-old man with relapsed multiple myeloma who was started on ixazomib, lenalidomide, and dexamethasone. He developed several skin lesions that were biopsied and revealed cutaneous necrotizing vasculitis. Ixazomib was held with resolution of the vasculitic lesions and restarted with dexamethasone to 20 mg on the day of treatment and 20 mg dose the day after treatment.

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Chalazia development in multiple myeloma: a new complication associated with bortezomib therapy

Hematology Reports ◽

10.4081/hr.2015.5729 ◽

2015 ◽

Vol 7 (2) ◽

Cited By ~ 5

Author(s):

Charles Yun ◽

Nikhil Mukhi ◽

Valerie Kremer ◽

Roman Shinder ◽

Vaibhav Verma ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Side Effects ◽

Boronic Acid ◽

Proteasome Inhibitor ◽

Plasma Cells ◽

Selective Inhibitor ◽

26S Proteasome ◽

Kappa Light Chain ◽

Ocular Side

Multiple myeloma (MM) is a neoplasm of plasma cells within the bone marrow. A major impact on improving survival in MM has been the use of the boronic acid-derived proteasome inhibitor bortezomib, a first-in-class selective inhibitor of the 26S proteasome. Ocular side effects of bortezomib are rare. In this report, we present 2 patients with active MM in whom persistent chalazia became a therapy-interfering complication of treatment with bortezomib. Both patients had relapsed ISS III B kappa light chain myeloma, and they were responding to treatment with bortezomib until chalazia − which caused intolerable discomfort − started. In both patients discontinuation of bortezomib was necessary for chalazia to heal, and restarting of bortezomib was associated with relapse of chalazia.

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Hydroxyurea Associated Cutaneous Lesions: A Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.320 ◽

2018 ◽

Vol 6 (8) ◽

pp. 1458-1461 ◽

Cited By ~ 6

Author(s):

Viktor Simeonovski ◽

Hristina Breshkovska ◽

Silvija Duma ◽

Ivana Dohcheva-Karajovanov ◽

Katerina Damevska ◽

...

Keyword(s):

Side Effects ◽

Actinic Keratosis ◽

Myeloproliferative Disorders ◽

Skin Lesions ◽

Term Therapy ◽

Cutaneous Lesions ◽

Cutaneous Side Effects ◽

Dermatological Examination ◽

The Right ◽

Hands And Feet

BACKGROUND: Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas.CASE REPORT: We report a case of a 52-year-old man, on long-term therapy with HU for essential thrombocytosis, with several concurrent skin lesions. Despite the perennial use of HU, the cutaneous changes were neglected. The local dermatological examination revealed oval perimalleolar ulcer on the right leg, with dimensions 6 x 4 cm, clearly demarcated from the surroundings with regular margins, periulcerous erythema, with very deep and highly fibrinous bed of the ulcer, positive for bacterial infection. The ulcer was treated with topical wound therapy with alginate and parenteral antibiotics. The extended dermatological screening also showed two nummular lesions in the right brachial region, presenting as erythematous papules with sharp margins from the surrounding skin, gritty desquamation and dotted hyperpigmentations inside the lesion. Further dermoscopy and biopsy investigations confirmed a diagnosis of basal cell carcinoma. Nasal actinic keratosis was also noted. The patient was advised for discontinuing or substituting the HU therapy.CONCLUSION: We present this case to draw attention to the various cutaneous side effects that occur with perennial HU use and suggest an obligatory reference to a dermatological consult.

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Heart failure secondary to carfilzomib-induced heart block in multiple myeloma patients

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155215626788 ◽

2016 ◽

Vol 23 (2) ◽

pp. 152-156 ◽

Cited By ~ 6

Author(s):

Harisios Tjionas ◽

Amit K Gupta

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Multiple Myeloma ◽

Case Report ◽

Side Effects ◽

Proteasome Inhibitor ◽

Heart Block ◽

Irreversible Inhibitor ◽

The Difference ◽

Cardiac Manifestations

Carfilzomib is a proteasome inhibitor and immunomodulator used to treat patients with multiple myeloma who have disease progression refractory to bortezomib. The difference in agents is that carfilzomib is an irreversible inhibitor of 20 s proteasome. The most common side effects of carfilzomib are fatigue, nausea, diarrhea, anemia, thrombocytopenia, dyspnea, and pyrexia. Less frequent side effects include cardiac manifestations for which we will explore with more detail. In this case report, we describe a 70-year-old female with multiple myeloma presenting to the emergency department with complaint of dyspnea. Patient was discovered to be in heart failure with atrioventricular block necessitating placement of a pacemaker.

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BORTEZOMIB INDUCED SUBCONJUNCTIVAL HEMORRHAGE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i4.16907 ◽

2017 ◽

Vol 10 (4) ◽

pp. 10 ◽

Cited By ~ 1

Author(s):

Navin Patil ◽

Balaji Ommurugan ◽

Karthik S Udupa ◽

Karthik Rao

Keyword(s):

Adverse Effect ◽

Multiple Myeloma ◽

Side Effects ◽

Boronic Acid ◽

Rare Case ◽

Tertiary Care ◽

Molecular Formula ◽

Subconjunctival Hemorrhage ◽

Apoptotic Proteins

ABSTRACTMany drugs are used in the treatment of multiple myeloma but Thalidomide, Lenalidomide, Bortezomib, dexamethasone and their combination remains the main stay of treatment. The molecular formula of bortezomib is C19H25BN4O4 and its chemical IUPAC name is [3-methyl-1-(3-phenyl-2-pyrazin-2-ylcarbonylamino-propanoyl) amino-butyl] boronic acid. Mechanisms by which it acts is usually by 26 SProteasome inhibition leading to degradation of anti-apoptotic proteins. Bortezomib is known to cause many side effects. So hence we report a rare case of Bortezomib induced subconjunctival hemorrhage in our tertiary care hospital.KEYWORDS: Bortezomib, Adverse effect, Proteosome inhibition, Subconjunctival Hemorrhage

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Cutaneous genital complications of antiangiogenic agents

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e14568 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e14568-e14568

Author(s):

C. Mateus ◽

C. Massard ◽

G. Tomasic ◽

J. Wechsler ◽

V. Boige ◽

...

Keyword(s):

Side Effects ◽

Side Effect ◽

Cell Cancer ◽

Skin Lesions ◽

Antiangiogenic Agents ◽

Topical Steroids ◽

Cancer Therapies ◽

Cutaneous Side Effects ◽

Treatment Interruptions ◽

Vegfr Inhibitor

e14568 Background: Multikinase inhibitors targeting VEGFR, i.e. sorafenib and sunitinib are associated with various cutaneous side effects (1). Five cases of scrotal skin lesions were recently reported in male patients treated with sunitinib (2). Our observations of 8 patients presenting with genital inflammatory lesions during various anti-VEGFR therapies show that this side effect is linked to VEGFR blockade and not specifically to sunitinib and that it can also occur in women. Results: Six men and two women were seen for a genital eruption. They were treated with sorafenib (3 pts), sunitinib (5 pts), and a new pan-HER and VEGFR inhibitor (BMS 514, EVRI) (1 pt) for renal cell cancer (4 pts), hepatocellular carcinoma (2 pts), lung cancer (1 pt) and sarcoma (1 pt). Genital lesions occurred during the first six weeks of treatment. They appeared as a painful erythematous and squamous inguinal, intergluteal, and perianal rash rapidly involving all genital areas in 4 patients. Lesions became erosive in 3 cases. Four men presented more limited, pruriginous and lichenoid penile papules which were associated with a genital erythema for 3 of them. In one patient, penile inflammation resulted in a phimosis. One patient successively treated with sunitinib, sorafenib and once again with sunitinib experienced genital side effects with both agents. Patients taking sequential sunitinib treatment reported symptoms improvement during treatment interruptions and recurrences during the weeks on therapy. Microbiological samples were negative. Pathology of erythematous and squamous lesions showed a psoriasiform or a lichenoid aspect. Topical steroids were efficient for 5 patients but 3 patients had to interrupt anti-VEGF therapy because of their genital rash. Conclusions: Polymorphous genital inflammatory rash is a new skin side effect that can be associated with any cancer therapies targeting VEGFR in men and in women. Its frequency is unknown and probably underestimated because many patients might not report this side effect and its mechanism is still obscure. Physicians should be aware of this side effect and should inquire as to whether the patients have noticed such symptoms in order to avoid worsening thereof by symptomatic measures. No significant financial relationships to disclose.

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