Bortezomib-Induced Skin Eruption in Patient with Newly Diagnosed Multiple Myeloma under VRd Regime: A Case Report

Bortezomib-Induced Skin Eruption in Patient with Newly Diagnosed Multiple Myeloma under VRd Regime: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Bortezomib-Induced Skin Eruption in Patient with Newly Diagnosed Multiple Myeloma under VRd Regime: A Case Report Sudip Subedi, Pragya Gautam, Tek Nath Yogi, Rajeev Sharma, Soniya Dulal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7124847/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The proteasome inhibitor bortezomib is used to treat various hematological cancers. It is currently included in the standard of care for individuals receiving their first line treatment for a recently diagnosed multiple myeloma. Generally well tolerated, bortezomib has been linked to a number of side effects. In this instance, a reticular eruption that developed at the site of a subcutaneous bortezomib administration in a 45-year-old male patient with recently diagnosed multiple myeloma is described along with histological confirmation. After a skin biopsy, it was shown that the perivascular of lymphocytes and eosinophils admixed with neutrophils at dermis with unremarkable hypodermis. The patient responded well to betamethasone dipropionate 0.05% cream treatment. Oncology Dermatology Drug eruption Bortezomib Multiple Myeloma Histopathology Case report Figures Figure 1 Figure 2 Introduction Bortezomib, a proteasome inhibitor, is used to treat a variety of malignancies. It is currently part of the standard care regimen for the initial treatment of patients with newly diagnosed multiple myeloma[ 1 ]. Although generally well tolerated, bortezomib has been associated with various side effects, which have limited its use in some patients. Cutaneous adverse reactions to subcutaneous bortezomib administration have been reported, typically presenting as cutaneous nodules, plaques, or morbilliform erythema[ 2 ]. Additionally, bortezomib has also been linked to cutaneous vasculitis and neutrophilic dermatosis[ 3 ]. Bortezomib-related skin reactions generally occur after multiple treatment cycles. While they often resolve quickly following antihistamine and corticosteroid treatment or within a week of the last dose without pharmacological intervention, recurrence during subsequent treatment cycles can be challenging. Here, we describe a peculiar reticular rash with histopathological findings following the subcutaneous injection of bortezomib. Case Presentation The patient is a 45-year-old male, a non-smoker and non-alcohol consumer, who was newly diagnosed with standard-risk multiple myeloma. A month after the initial diagnosis, the patientbegan treatment. His first treatment cycle included 2 mg of injection bortezomib subcutaneous on days 1, 8, and 15; 25 mg of oral lenalidomide daily for 14 days and 1 week off and 20 mg of oral dexamethasone once a week, VRd regimen. Each medication was prescribed as part of a three-week treatment cycle. Additionally, the patient was started on 75 mg of aspirin daily for deep vein thrombosis prophylaxis and 400 mg of acyclovir daily for shingles prophylaxis. After the first injection of bortezomib in the third cycle, the patient developed an erythematous and mildly pruritic patch around the injection site on the left flank. The rash was characterized by finger-like projections and satellite lesions around the main rash, with the hair follicles within the rash remaining intact (Fig. 1 ;A,B). During the first cycle, the patient experienced no such skin changes. However, in the second cycle, a localized rash appeared that subsided on its own within three days. In the third cycle, the patchy rash was more extensive and persistent, prompting the patient to seek medical care. The patient was admitted for evaluation of the rash, and a dermatological consultation was conducted. A punch biopsy was performed in aseptic conditions on the fifth day of rash onset and sent for histopathological evaluation. The patient was prescribed topical steroid treatment with betamethasone dipropionate cream 0.05%. After one week of treatment, the rash began to disappear (Fig. 1 ;C). His treatment for multiple myeloma was continued as scheduled. The histopathological report reveal epidermis with hyperkeratosis, parakeratosis with irregular acanthosis and basal layer vaculor alteration. Papillary dermis shows perivascular and periadenxal inflammatory infiltrate including lymphocyte, eosinophils admixed with neutrophil. Vascular destruction due to inflammation and extravasation of erythrocyte. Reticular dermis shows lymphocyte and eosinophil. Hypodermis and subcutis unremarkable as shown in Fig. 2 ;A,B,C,D. Discussion There are several article reporting appearance of reticular pattern of skin rash following subcutaneous injection of bortezomib[ 4 ]. Bortezomib drug eruption mostly characterized by vasculitis with perivascular lymphocyte and eosinophil infiltration[ 5 ]. Herei in our case we also find neutrophil infiltration inside wall and in the vessel. Several literature reveal bortezomib induced sweets syndrome being based upon Walker and Cohen criteria. In this case despite of neutrophic infiltration in biopsy, criteria for acute neutrophilic dermatosis could not fulfilled. The subcutaneous route is commonly preferred to intravenous route. However, in cases where cutaneous reactions are severe, alternate approaches for administration i,e intravenous route could be consider. As literature reports that both subcutaneous and intravenous administration of Bortezomib have similar response rates, efficacies and rates of adverse events[ 6 ]. Consensus has been made to continue inj bortezomib despite of having skin eruption by oncology team under after several literature review. Study shows intravenous route associated with higer incidence of drug induced peripheral neuropathy[ 7 ][ 1 ]. Basically people who are at risk of having peripheral neuropathy should avoid intravenous route. In aggressive myeloma it is not advisable to stop bortezomib for concern of rash. In our case skin rash evaluate by dermatologist and treated with topical steroid and patient respond well to treatment. Some literature suggest treatment with both systemic as well topical steroid[ 8 ][ 9 ]. Despite of getting weekly dexamethasone as part of treatment regime for multiple myeloma patient developed rash, this shows role of systemic steroid in treatment of rash questionable. Comparison of the present case with the previously reported case is shown in the Table 1 . Table 1 Comparison of the present case with the previously reported cases. Parameter Özlü C.et al [ 10 ] Khaldy M et al[ 11 ] Han J et al [ 12 ] Present Case Age/Sex 71/Male 72/Female 62/Male 45/Male MM Treatment Regimen VCD (bortezomib, cyclophosphamide, dexamethasone) VTD → VD → VRD + denosumab VRd (bortezomib, lenalidomide, dexamethasone) VRd (bortezomib, lenalidomide, dexamethasone) Comorbidities None reported CKD (stage 3B), AF None mentioned None, non-smoker/non-alcoholic Route of Bortezomib IV Subcutaneous Subcutaneous Subcutaneous Timing of Rash After bortezomib infusion After last dose of bortezomib (VRD cycle) After first injection of 3rd cycle After first injection of 3rd cycle Skin Reaction Description Erythematous, edematous, painful patch at IV site; localized cellulitis-like lesion Generalized rash starting from palms/soles; itchy, raised, erythematous, edematous Pronounced erythematous, pruritic plaque with reticular pattern Erythematous patch with finger-like projections and satellite lesions Histopathology Findings Not performed Fixed drug eruption: necrotic keratinocytes, lichenoid infiltrates Superficial perivascular dermatitis with lymphocytes, rare eosinophils Hyperkeratosis, parakeratosis, irregular acanthosis, basal vacuolization, perivascular eosinophilic infiltrates Fever/Inflammatory Signs Subfebrile fever, CRP 25 mg/L Fever 37.8°C, hypotension (97/58 mmHg), O2 sat 91% — sepsis suspected None reported No systemic symptoms Infection Workup No thrombosis/cellulitis confirmed; piperacillin-tazobactam given Treated as septic shock with IV teicoplanin and ceftazidime Not applicable Not applicable Topical Treatment None Started on corticosteroids (systemic) Betamethasone dipropionate 0.05% cream Betamethasone dipropionate 0.05% cream Biopsy Timing Not done Done during hospitalization Day 8 of rash Day 5 of rash Treatment Outcome Rash resolved in 3 days with antibiotics; discharged after 10 days Patient deteriorated and died Rash resolved in 2–3 weeks; treatment restarted with no recurrence Rash resolved in 1 week; treatment continued Recurrence No further recurrence noted Not applicable (deceased) No recurrence No recurrence Other Notes First report of IV-site rash despite no SC route Rash was systemic, likely severe hypersensitivity Vascular pattern rash suggestive of injection reaction Satellite lesions and follicular sparing noted Another peculiar observation in our case there are some satellite lesion around main lesion. The possible explanation for that could be drug induced isomorphic phenomenon however no such phenomenon is observed during literature review. So research gap is created whether this drug is responsible for isomorphic phenomenon or not. Conclusion Bortezomib-induced skin rash is dermatological complication of subcutaneous administration of drug. In this case, we report a patient with an erythematous reticular skin rash that appeared on third cycle after the first exposure to bortezomib. It was confirmed with histopathological findings of perivascular eosinophilic and neutrophilic infiltrations on skin biopsy. Based on that, bortezomib-induced skin rash should be suspected in patients with new-onset skin rash even after several dosage of drug administration. We recommend not to stop bortezomib and use topical steroid for skin eruption. Abbreviations MM – Multiple Myeloma VCD – Bortezomib, Cyclophosphamide, Dexamethasone VTD – Bortezomib, Thalidomide, Dexamethasone VD – Bortezomib, Dexamethasone VRD / VRd – Bortezomib, Lenalidomide, Dexamethasone IV – Intravenous SC / SQ – Subcutaneous CRP – C-Reactive Protein CKD – Chronic Kidney Disease AF – Atrial Fibrillation O2 sat – Oxygen Saturation PO – Per Oral (by mouth) PRN – As Needed mg/m² – Milligrams per Square Meter (body surface area dosing) Declarations Funding: This research received no external funding. Ethical approval : The study is exempt/waived from ethical approval in our institu tion as it poses minimal risk to the patient and the study is for educational purpose/activities. Informed Consent Statement : Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the writ ten consent is available for review by the Editor-in-Chief of this journal on request. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Authors' Contributions SS (Sudip Subedi) and PG (Pragya Gautam) contributed to the initial diagnosis, clinical evaluation, and preparation of the manuscript draft. TNY (Tek Nath Yogi) assisted in literature review and manuscript editing. RS (Rajiv Sharma) and SD (Soniya Dulal) supervised the case management, confirmed the diagnosis, and critically revised the manuscript. Data availability statement : N/A. Acknowedgements: N/A References Moreau P et al (May 2011) Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study. Lancet Oncol 12(5):431–440 Villarrubia B, Betlloch I, Mataix J, Lucas A, Botella C (2007) Bortezomib-associated rash: a new recognizable and avoidable side-effect., The British journal of dermatology , vol. 156, no. 4. England, pp. 784–785, Apr. 10.1111/j.1365-2133.2007.07757.x Garcia-Navarro X, Puig L, Fernández-Figueras MT, Dalmau J, Roe E, Alomar A (2007) Bortezomib-associated cutaneous vasculitis., The British journal of dermatology , vol. 157, no. 4. England, pp. 799–801, Oct. 10.1111/j.1365-2133.2007.08073.x Han J et al (2023) Bortezomib-Induced Reticular Eruption in Patient with Multiple Myeloma. Dermatopathology 10(3):226–230. 10.3390/dermatopathology10030031 Ozkurt ZN, Sucak GT, Aki SZ, Yağci M, Erdem O (2009) Bortezomib-induced perivascular dermatitis in a patient with multiple myeloma. Cutan Ocul Toxicol 28(3):141–143. 10.1080/15569520903046934 Loke C et al (2020) Sep., Bortezomib use and outcomes for the treatment of multiple myeloma., Intern. Med. J. , vol. 50, no. 9, pp. 1059–1066. 10.1111/imj.14886 Minarik J et al (2012) Subcutaneous Bortezomib in Multiple Myeloma Patients Induces Similar Therapeutic Response Rates as Intravenous Application But It Does Not Reduce the Incidence of Peripheral Neuropathy, no. January pp. 1–10, 2015. 10.1371/journal.pone.0123866 Khaldy M, Hamdan S, Amar M, Alshyoukhi M, Arafat H (Nov. 2023) Skin Rash as a Side Effect of Bortezomib: A Case Report. Cureus 15:e49051 11. United States. 10.7759/cureus.49051 Wu KL, Heule F, Lam K, Sonneveld P (2006) Pleomorphic presentation of cutaneous lesions associated with the proteasome inhibitor bortezomib in patients with multiple myeloma., J. Am. Acad. Dermatol. , vol. 55, no. 5, pp. 897–900, Nov. 10.1016/j.jaad.2006.06.030 Özlü C, Yalçın N, Gönderen A, Keskin Dilek,Skin reaction due to intravenous bortezomib in a multiple myeloma patientDemiroglu Science University Florence Nightingale. J Med 7,no. 3. pp -297-299,2022 doi:10.5606/fng.btd.2021.54 Khaldy M, Hamdan S, Amar M, Alshyoukhi M, Arafat H (2023) Skin Rash as a Side Effect of Bortezomib: A Case Report. Cureus 15(11):e49051. 10.7759/cureus.49051 PMID: 38116361; PMCID: PMC10729842 Han J, Owji S, Agarwal A, Kamat S, Luu Y, Mubasher A, Niedt G, Ray C, Cho HJ, Gulati N, Lamb A (2023) Bortezomib-Induced Reticular Eruption in Patient with Multiple Myeloma. Dermatopathol (Basel) 10(3):226–230. 10.3390/dermatopathology10030031 PMID: 37489455; PMCID: PMC10366922 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7124847","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":485416591,"identity":"4cbf816f-7ea0-49ae-a89a-7883a5602542","order_by":0,"name":"Sudip Subedi","email":"","orcid":"","institution":"Junior Resident, Department of Internal Medicine, B.P Koirala Institute of Health Science","correspondingAuthor":false,"prefix":"","firstName":"Sudip","middleName":"","lastName":"Subedi","suffix":""},{"id":485416592,"identity":"9f5f0c73-b5f7-4b64-abe4-ec580f239e78","order_by":1,"name":"Pragya Gautam","email":"","orcid":"","institution":"Junior Resident, Department of Dermatology, B.P Koirala Institute of Health Science","correspondingAuthor":false,"prefix":"","firstName":"Pragya","middleName":"","lastName":"Gautam","suffix":""},{"id":485416593,"identity":"6624f000-8825-44a2-b28b-193d552c8156","order_by":2,"name":"Tek Nath Yogi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYJCCAwwMCUCKh+HAByDFxk6MlgMgLWw8jAdngLQwE2cNWAvzYR4Qj5AWg+PtFw9/qEjL45/fe+Cwza9t8nzMDIwfPubg0XLmTMGBA2dyiiWO8SUczu27bdjGzMAsOXMbHi03chIOHGyrSGw4xmNwOLfnNiNQCxszL0Et/yoS54O0WPbctidCS/qBAwcbchI3gLQw/LidSFCL5JkzDAfOHEtL3Hgsx+Bgb8Pt5DZmxma8fuE73v74Q0VNcuK8w2eMP/z4c9t2fnvzwQ8f8WhROMBjgOAxtoHJBtzqgUC+gf0BEvcPXsWjYBSMglEwQgEAyqRhUxOCoDkAAAAASUVORK5CYII=","orcid":"","institution":"Intern, Department of Internal Medicine, B.P Koirala Institute of Health Science","correspondingAuthor":true,"prefix":"","firstName":"Tek","middleName":"Nath","lastName":"Yogi","suffix":""},{"id":485416594,"identity":"c2e400c7-dbce-45f7-a638-768805050dba","order_by":3,"name":"Rajeev Sharma","email":"","orcid":"","institution":"Consultant Oncologist, Department of Internal Medicine, B.P Koirala Institute of Health Science","correspondingAuthor":false,"prefix":"","firstName":"Rajeev","middleName":"","lastName":"Sharma","suffix":""},{"id":485416595,"identity":"98092070-eeaa-4a03-89ad-b83b93fffcb7","order_by":4,"name":"Soniya Dulal","email":"","orcid":"","institution":"Consultant Oncologist, Department of Internal Medicine, B.P Koirala Institute of Health Science","correspondingAuthor":false,"prefix":"","firstName":"Soniya","middleName":"","lastName":"Dulal","suffix":""}],"badges":[],"createdAt":"2025-07-14 23:53:18","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7124847/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7124847/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87048341,"identity":"ae568999-2531-4b06-8ab0-3071b513e4a6","added_by":"auto","created_at":"2025-07-18 14:48:02","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":365082,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSkin rashes following bortezomib injection\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe rashes show by finger-like projections and satellite lesions around the main rash, with the hair follicles within the rash remaining intact (A,B); Resolving rashes (C).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7124847/v1/ab2857ee17fd263e04d74602.jpeg"},{"id":87045595,"identity":"1015b993-f339-4e48-a1ed-3bd52c484b43","added_by":"auto","created_at":"2025-07-18 14:32:02","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":266677,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistopathological examination of skin biopsy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSection A: Neutrophils inside wall and vessel, Section B: Short arrow shows eosinophil within vessel, long arrow erythrocyte within interstitium, Section C: Extravasated erythrocyte, endothelial cell swelling with vascular damage\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7124847/v1/6946050ab158285772e751d2.jpeg"},{"id":87233605,"identity":"b7acbad9-3d39-4fa8-9baa-e4717a6472be","added_by":"auto","created_at":"2025-07-21 20:08:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1240029,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7124847/v1/53008dd4-7b45-4a83-8909-9a9c90825c11.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eBortezomib-Induced Skin Eruption in Patient with Newly Diagnosed Multiple Myeloma under VRd Regime: A Case Report\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBortezomib, a proteasome inhibitor, is used to treat a variety of malignancies. It is currently part of the standard care regimen for the initial treatment of patients with newly diagnosed multiple myeloma[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although generally well tolerated, bortezomib has been associated with various side effects, which have limited its use in some patients. Cutaneous adverse reactions to subcutaneous bortezomib administration have been reported, typically presenting as cutaneous nodules, plaques, or morbilliform erythema[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, bortezomib has also been linked to cutaneous vasculitis and neutrophilic dermatosis[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Bortezomib-related skin reactions generally occur after multiple treatment cycles. While they often resolve quickly following antihistamine and corticosteroid treatment or within a week of the last dose without pharmacological intervention, recurrence during subsequent treatment cycles can be challenging. Here, we describe a peculiar reticular rash with histopathological findings following the subcutaneous injection of bortezomib.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eThe patient is a 45-year-old male, a non-smoker and non-alcohol consumer, who was newly diagnosed with standard-risk multiple myeloma. A month after the initial diagnosis, the patientbegan treatment. His first treatment cycle included 2 mg of injection bortezomib subcutaneous on days 1, 8, and 15; 25 mg of oral lenalidomide daily for 14 days and 1 week off and 20 mg of oral dexamethasone once a week, VRd regimen. Each medication was prescribed as part of a three-week treatment cycle. Additionally, the patient was started on 75 mg of aspirin daily for deep vein thrombosis prophylaxis and 400 mg of acyclovir daily for shingles prophylaxis.\u003c/p\u003e\u003cp\u003eAfter the first injection of bortezomib in the third cycle, the patient developed an erythematous and mildly pruritic patch around the injection site on the left flank. The rash was characterized by finger-like projections and satellite lesions around the main rash, with the hair follicles within the rash remaining intact (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e;A,B). During the first cycle, the patient experienced no such skin changes. However, in the second cycle, a localized rash appeared that subsided on its own within three days. In the third cycle, the patchy rash was more extensive and persistent, prompting the patient to seek medical care.\u003c/p\u003e\u003cp\u003eThe patient was admitted for evaluation of the rash, and a dermatological consultation was conducted. A punch biopsy was performed in aseptic conditions on the fifth day of rash onset and sent for histopathological evaluation. The patient was prescribed topical steroid treatment with betamethasone dipropionate cream 0.05%. After one week of treatment, the rash began to disappear (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e;C). His treatment for multiple myeloma was continued as scheduled.\u003c/p\u003e\u003cp\u003eThe histopathological report reveal epidermis with hyperkeratosis, parakeratosis with irregular acanthosis and basal layer vaculor alteration. Papillary dermis shows perivascular and periadenxal inflammatory infiltrate including lymphocyte, eosinophils admixed with neutrophil. Vascular destruction due to inflammation and extravasation of erythrocyte. Reticular dermis shows lymphocyte and eosinophil. Hypodermis and subcutis unremarkable as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e;A,B,C,D.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere are several article reporting appearance of reticular pattern of skin rash following subcutaneous injection of bortezomib[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Bortezomib drug eruption mostly characterized by vasculitis with perivascular lymphocyte and eosinophil infiltration[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Herei in our case we also find neutrophil infiltration inside wall and in the vessel. Several literature reveal bortezomib induced sweets syndrome being based upon Walker and Cohen criteria. In this case despite of neutrophic infiltration in biopsy, criteria for acute neutrophilic dermatosis could not fulfilled.\u003c/p\u003e\u003cp\u003eThe subcutaneous route is commonly preferred to intravenous route. However, in cases where cutaneous reactions are severe, alternate approaches for administration i,e intravenous route could be consider. As literature reports that both subcutaneous and intravenous administration of Bortezomib have similar response rates, efficacies and rates of adverse events[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Consensus has been made to continue inj bortezomib despite of having skin eruption by oncology team under after several literature review. Study shows intravenous route associated with higer incidence of drug induced peripheral neuropathy[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Basically people who are at risk of having peripheral neuropathy should avoid intravenous route. In aggressive myeloma it is not advisable to stop bortezomib for concern of rash. In our case skin rash evaluate by dermatologist and treated with topical steroid and patient respond well to treatment. Some literature suggest treatment with both systemic as well topical steroid[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite of getting weekly dexamethasone as part of treatment regime for multiple myeloma patient developed rash, this shows role of systemic steroid in treatment of rash questionable. Comparison of the present case with the previously reported case is shown in the Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the present case with the previously reported cases.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026Ouml;zl\u0026uuml; C.et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKhaldy M et al[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHan J et al [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePresent Case\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge/Sex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71/Male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72/Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62/Male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45/Male\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMM Treatment Regimen\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVCD (bortezomib, cyclophosphamide, dexamethasone)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVTD \u0026rarr; VD \u0026rarr; VRD\u0026thinsp;+\u0026thinsp;denosumab\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVRd (bortezomib, lenalidomide, dexamethasone)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVRd (bortezomib, lenalidomide, dexamethasone)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone reported\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCKD (stage 3B), AF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone mentioned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNone, non-smoker/non-alcoholic\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRoute of Bortezomib\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSubcutaneous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSubcutaneous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSubcutaneous\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTiming of Rash\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter bortezomib infusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter last dose of bortezomib (VRD cycle)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAfter first injection of 3rd cycle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAfter first injection of 3rd cycle\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSkin Reaction Description\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eErythematous, edematous, painful patch at IV site; localized cellulitis-like lesion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGeneralized rash starting from palms/soles; itchy, raised, erythematous, edematous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePronounced erythematous, pruritic plaque with reticular pattern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eErythematous patch with finger-like projections and satellite lesions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistopathology Findings\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot performed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFixed drug eruption: necrotic keratinocytes, lichenoid infiltrates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSuperficial perivascular dermatitis with lymphocytes, rare eosinophils\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHyperkeratosis, parakeratosis, irregular acanthosis, basal vacuolization, perivascular eosinophilic infiltrates\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFever/Inflammatory Signs\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubfebrile fever, CRP 25 mg/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFever 37.8\u0026deg;C, hypotension (97/58 mmHg), O2 sat 91% \u0026mdash; sepsis suspected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone reported\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo systemic symptoms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInfection Workup\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo thrombosis/cellulitis confirmed; piperacillin-tazobactam given\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTreated as septic shock with IV teicoplanin and ceftazidime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTopical Treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStarted on corticosteroids (systemic)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBetamethasone dipropionate 0.05% cream\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBetamethasone dipropionate 0.05% cream\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBiopsy Timing\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot done\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDone during hospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDay 8 of rash\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay 5 of rash\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTreatment Outcome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRash resolved in 3 days with antibiotics; discharged after 10 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatient deteriorated and died\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRash resolved in 2\u0026ndash;3 weeks; treatment restarted with no recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRash resolved in 1 week; treatment continued\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRecurrence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo further recurrence noted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot applicable (deceased)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo recurrence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther Notes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFirst report of IV-site rash despite no SC route\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRash was systemic, likely severe hypersensitivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVascular pattern rash suggestive of injection reaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSatellite lesions and follicular sparing noted\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnother peculiar observation in our case there are some satellite lesion around main lesion. The possible explanation for that could be drug induced isomorphic phenomenon however no such phenomenon is observed during literature review. So research gap is created whether this drug is responsible for isomorphic phenomenon or not.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBortezomib-induced skin rash is dermatological complication of subcutaneous administration of drug. In this case, we report a patient with an erythematous reticular skin rash that appeared on third cycle after the first exposure to bortezomib. It was confirmed with histopathological findings of perivascular eosinophilic and neutrophilic infiltrations on skin biopsy. Based on that, bortezomib-induced skin rash should be suspected in patients with new-onset skin rash even after several dosage of drug administration. We recommend not to stop bortezomib and use topical steroid for skin eruption.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eMM\u003c/strong\u003e – Multiple Myeloma\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVCD\u003c/strong\u003e – Bortezomib, Cyclophosphamide, Dexamethasone\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVTD\u003c/strong\u003e – Bortezomib, Thalidomide, Dexamethasone\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVD\u003c/strong\u003e – Bortezomib, Dexamethasone\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVRD / VRd\u003c/strong\u003e – Bortezomib, Lenalidomide, Dexamethasone\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIV\u003c/strong\u003e – Intravenous\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSC / SQ\u003c/strong\u003e – Subcutaneous\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCRP\u003c/strong\u003e – C-Reactive Protein\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCKD\u003c/strong\u003e – Chronic Kidney Disease\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAF\u003c/strong\u003e – Atrial Fibrillation\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eO2 sat\u003c/strong\u003e – Oxygen Saturation\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePO\u003c/strong\u003e – Per Oral (by mouth)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePRN\u003c/strong\u003e – As Needed\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003emg/m²\u003c/strong\u003e – Milligrams per Square Meter (body surface area dosing)\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval :\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study is exempt/waived from ethical approval in our institu tion as it poses minimal risk to the patient and the study is for educational purpose/activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication and any accompanying images. A copy of the writ ten consent is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSS\u003c/strong\u003e (Sudip Subedi) and\u0026nbsp;\u003cstrong\u003ePG\u003c/strong\u003e (Pragya Gautam) contributed to the initial diagnosis, clinical evaluation, and preparation of the manuscript draft.\u003cbr\u003e\u003cstrong\u003eTNY\u003c/strong\u003e (Tek Nath Yogi) assisted in literature review and manuscript editing.\u003cbr\u003e\u003cstrong\u003eRS\u003c/strong\u003e (Rajiv Sharma) and \u003cstrong\u003eSD\u003c/strong\u003e (Soniya Dulal) supervised the case management, confirmed the diagnosis, and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement :\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN/A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowedgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eN/A\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoreau P et al (May 2011) Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study. Lancet Oncol 12(5):431\u0026ndash;440\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVillarrubia B, Betlloch I, Mataix J, Lucas A, Botella C (2007) Bortezomib-associated rash: a new recognizable and avoidable side-effect., \u003cem\u003eThe British journal of dermatology\u003c/em\u003e, vol. 156, no. 4. England, pp. 784\u0026ndash;785, Apr. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-2133.2007.07757.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2133.2007.07757.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarcia-Navarro X, Puig L, Fern\u0026aacute;ndez-Figueras MT, Dalmau J, Roe E, Alomar A (2007) Bortezomib-associated cutaneous vasculitis., \u003cem\u003eThe British journal of dermatology\u003c/em\u003e, vol. 157, no. 4. 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Cureus 15(11):e49051. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.49051\u003c/span\u003e\u003cspan address=\"10.7759/cureus.49051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 38116361; PMCID: PMC10729842\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHan J, Owji S, Agarwal A, Kamat S, Luu Y, Mubasher A, Niedt G, Ray C, Cho HJ, Gulati N, Lamb A (2023) Bortezomib-Induced Reticular Eruption in Patient with Multiple Myeloma. Dermatopathol (Basel) 10(3):226\u0026ndash;230. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/dermatopathology10030031\u003c/span\u003e\u003cspan address=\"10.3390/dermatopathology10030031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 37489455; PMCID: PMC10366922\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"B.P. Koirala Institute of Health Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Drug eruption, Bortezomib, Multiple Myeloma, Histopathology, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7124847/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7124847/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe proteasome inhibitor bortezomib is used to treat various hematological cancers. It is currently included in the standard of care for individuals receiving their first line treatment for a recently diagnosed multiple myeloma. Generally well tolerated, bortezomib has been linked to a number of side effects. In this instance, a reticular eruption that developed at the site of a subcutaneous bortezomib administration in a 45-year-old male patient with recently diagnosed multiple myeloma is described along with histological confirmation. After a skin biopsy, it was shown that the perivascular of lymphocytes and eosinophils admixed with neutrophils at dermis with unremarkable hypodermis. The patient responded well to betamethasone dipropionate 0.05% cream treatment.\u003c/p\u003e","manuscriptTitle":"Bortezomib-Induced Skin Eruption in Patient with Newly Diagnosed Multiple Myeloma under VRd Regime: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:31:57","doi":"10.21203/rs.3.rs-7124847/v1","editorialEvents":[{"type":"communityComments","content":1}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d22a4fc-2667-4313-8d9f-c6d06ac41c4e","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51603288,"name":"Oncology"},{"id":51603289,"name":"Dermatology"}],"tags":[],"updatedAt":"2025-07-18T14:31:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:31:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7124847","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7124847","identity":"rs-7124847","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}