Ixazomib
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Systemic Varicella zoster infection: case report A 58-year-old man developed systemic Varicella zoster virus infection during treatment with ixazomib for multiple myeloma. The man, who had been diagnosed with symptomatic multiple myeloma, subsequently received bortezomib, dexamethasone and doxorubicin, resulting in a stringent complete response. Thereafter, he underwent autologous peripheral blood stem cell transplantation and received zoledronic acid [zoledronate]. However, a symptomatic recurrence was detected in August 2018. Therefore, he started receiving ixazomib [route and dosage not stated], lenalidomide and dexamethasone (IRd regimen), and after 5 cycles, he achieved a stringent complete response. The treatment was continued. Cycle 10 started in May 2019; and on day 10, he developed a fever of 38°C, accompanied by a generalised skin eruption with vesicles. Headache and dizziness followed. He was urgently hospitalised due to suspicion of a central nervous system infection associated with generalised herpes zoster. Of note, his past medical history was notable for Varicella in childhood, and he had not received vaccination for Varicella. On admission, his vital signs were as follows: temperature 35.4°C, pulse rate 80 /min, BP 117/78mm Hg and oxygen saturation 97% (on room air). His consciousness was clear, as were the lung fields. Heart sounds were pure. Heart murmurs were not heard. His abdomen was flat and soft, without tenderness. His liver and spleen were not palpable. Scattered red papules with pustules, blisters and crusting were noted on his face, head and back of the chest [sic]. Laboratory findings were notable for positive Varicella zoster virus-IgM and IgG. CSF examination revealed an increase in protein and lymphocytes. Varicella zoster virus DNA at 4 000 copies/mL was detected in a quantitative PCR. Further, immunochromatography of a blister swab was found to be Varicella zoster virus antigen-positive; hence, he was diagnosed with a systemic Varicella zoster virus infection, involving infection of the central nervous system. The systemic Varicella zoster virus infection was attributed to the treatment with ixazomib. The man was treated with IV aciclovir, and 3 days later, the eruptions started to disappear, with crusting. The light-headedness and dizziness improved after about day 10. CSF analysis on day 12 confirmed negative Varicella zoster virus-DNA and decreased protein. He received IV aciclovir for 15 days, after which he continued receiving the IRd regimen alongside oral aciclovir as prophylaxis. He experienced no further recurrence of Varicella zoster virus infection. Nakayama H, et al. Systemic varicella-zoster infection during ixazomib-containing multiagent chemotherapy for multiple myeloma. Rinsho Ketsueki 61: 870-873, No. 8, 2020. 803519980 Available from: URL: http://doi.org/10.11406/rinketsu.61.870 [Japanese; summarised from a translation]
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Reactions 12 Dec 2020 No. 1834
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