Herpes zoster complicating bortezomib therapy.

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 (Figs A, B). Tzanck smear showed multinucleated giant cells confirming the diagnosis of herpes zoster (Figs 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 infection12. Considering two earlier studies34 and our case, it is emphasised that acyclovir prophylaxis should be used during bortezomib treatment.

Figs

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. Figs C, D. Light microscopy using tzanck smear and stained with Wright-Giemsa stain showing giant cells.