Bortezomib
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Enterocolitis (first report) in an elderly patient: case report A 65-year-old woman developed acute enterocolitis during treatment with bortezomib for multiple myeloma. The woman, who had previously received various antineoplastics, started receiving cycles of bortezomib 1.3 mg/m2/day on days 1, 4, 8 and 11 and dexamethasone in April 2006. During the first cycle, she had evidence of herpes zoster. On day 24 of her first cycle, she was readmitted with neuropathic pain and erythematous skin rashes with pustules in her left posterior thigh region. She was diagnosed with lumbar herpes zoster and received valaciclovir. Following herpes zoster relief, she started receiving the second bortezomib cycle and, 2 days later, she developed tenesmus and her faecal incontinence worsened. Abdominal examination showed discomfort in her left lower quadrant with mild tenderness. She had a WBC count of 6.6 × 109/L with 71% neutrophils and a C-reactive protein level of 12.62 mg/L (baseline 2.5 mg/L). A pelvic MRI revealed diffuse bowel wall thickening of her sigmoid colon and rectum. A sigmoidoscopy revealed pseudomembrane formation with yellowish exudates from her sigmoid colon to her rectum, with adjacent oedematous and pale mucosa. Findings were consistent with acute enterocolitis and a colon mucosal biopsy revealed pathological findings consistent with acute enterocolitis. A Clostridium difficile toxin assay performed on a stool sample was positive. Bortezomib was discontinued and the woman received metronidazole. Her GI symptoms improved and, after 10 days of metronidazole treatment, a repeat sigmoidoscopy and mucosal biopsy revealed improvement of her mucosal lesion. [Patient outcome not clearly stated.] Author comment: "Bortezomib is a small, dipeptidyl boronate molecule which differs considerably from β-lactams but nevertheless inhibits the enzyme well. . . We postulate that [acute enterocolitis] occurring in our patient may be caused by disruption of normal colonic microflora made by the antibiotic effects of boronic acid-based compounds." Moon S-J, et al. Pseudomembranous colitis following bortezomib therapy in a myeloma patient. Acta Haematologica 117: 211-214, No. 4, 2007 - South 801078826 Korea
» Editorial comment: A search of AdisBase, Medline and the WHO Adverse Drug Reactions database did not reveal any previous case reports of enterocolitis associated with bortezomib.
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Reactions 14 Jul 2007 No. 1160
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