Bortezomib-induced Purpuric Rash in Multiple Myeloma

Multiple myeloma (MM) accounts for 1-2% of all cancers and more than 17% of haematologic malignancies, [1] characterised by monoclonal plasma cell proliferation in bone marrow with production of a homogeneous immunoglobulin (M-protein).Bortezomib is the first of a new class of drugs known as proteasome inhibitors, currently used as standard of care in its treatment. [1]It has been linked to a number of cutaneous side effects; however, not all are well characterised. [1,2]We report two cases of drug-induced cutaneous leukocytoclastic vasculitis (LCV) following bortezomib therapy.The first case was a 68-year-old man diagnosed case of advanced stage multiple myeloma, immunoglobulin G kappa type, presenting with asymptomatic, erythematous, non-blanchable, purpuric patches over the thighs for a week [Figure 1a].He had received two injections of bortezomib (2 mg/m 2 ) subcutaneously on days 1 and 4, followed by the development of the rash after the second dose on day 8. Blood reports revealed anaemia (haemoglobin -8 g/dL) and hypercalcaemia (serum corrected calcium -11 mg/dL).