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CLINICAL IMAGES
Year : 2015  |  Volume : 141  |  Issue : 2  |  Page : 247-248

Herpes zoster complicating bortezomib therapy


Clinical Hematology, Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Web Publication21-Apr-2015

Correspondence Address:
Subhash Chander Varma
Clinical Hematology, Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.155599

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How to cite this article:
Sahu KK, Varma SC. Herpes zoster complicating bortezomib therapy. Indian J Med Res 2015;141:247-8

How to cite this URL:
Sahu KK, Varma SC. Herpes zoster complicating bortezomib therapy. Indian J Med Res [serial online] 2015 [cited 2020 Jul 6];141:247-8. Available from: http://www.ijmr.org.in/text.asp?2015/141/2/247/155599

A 62 year old female patient with multiple myeloma was on follow up in the Haematology clinic, department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, and was receiving bortezomib based chemotherapy given on days 1, 4, 8, and 11 of 35-day cycle. After two such cycles in June 2013, she started developing painful skin lesions on right D9-10 dermatome. On examination erythematous, crusted superficial erosions with a few vesicular lesions were present ([Figure 1] A, B). Tzanck smear showed multinucleated giant cells confirming the diagnosis of herpes zoster ([Figure 1] C, D). It was found that despite advice she did not take acyclovir prophylaxis during chemotherapy which led to this complication. She was given oral valganciclovir 1 g thrice a day for 10 days. Unfortunately, she was lost to follow up. There are theories which explain increased susceptibility of patients on bortezomib to herpes infection [1],[2] . Considering two earlier studies [3],[4] and our case, it is emphasised that acyclovir prophylaxis should be used during bortezomib treatment.
Figure 1 A, B. Well defined erythematous, crusted erosions with a few vesicular lesions (indicated by black arrows in (B) in a linear pattern over the right D 9-10 dermatome. Figure 1 C, D. Light microscopy using tzanck smear and stained with Wright-Giemsa stain showing giant cells.

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   References Top

1.
Swaika A, Paulus A, Miller KC, Sher T, Almyroudis NG, Ball D, et al. Acyclovir prophylaxis against varicella zoster virus reactivation in multiple myeloma patients treated with bortezomib-based therapies: a retrospective analysis of 100 patients. J Support Oncol 2012; 10 : 155-9.   Back to cited text no. 1
    
2.
Argyriou AA, Iconomou G, Kalofonos HP. Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature. Blood 2008; 112 : 1593-9.  Back to cited text no. 2
    
3.
Vickrey E, Allen S, Mehta J, Singhal S. Acyclovir to prevent reactivation of varicella zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy. Cancer 2009; 115 : 229-32.  Back to cited text no. 3
    
4.
Aoki T, Nishiyama T, Imahashi N, Kitamura K. Efficacy of continuous, daily, oral, ultra-low-dose 200 mg acyclovir to prevent herpes zoster events among bortezomib-treated patients: a report from retrospective study. Jpn J Clin Oncol 2011; 41 : 876-81.  Back to cited text no. 4
    


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