Clinical Variant of Serpentine Supravenous Hyperpigmentation Following Subcutaneous Bortezomib Injection

Bortezomib is a reversible proteasome inhibitor that is a first-line chemotherapeutic agent for multiple myeloma. Bortezomib can be administered intravenously or subcutaneously with similar efficacy. Subcutaneous administration has fewer side effects. Many cutaneous reactions have been associated with bortezomib treatment. These include morbilliform exanthems, erythematous nodules and papules, leukocytoclastic vasculitis, Sweet syndrome, and rarely Stevens-Johnson Syndrome.

This paper reports the occurrence of serpentine supravenous hyperpigmentation (SSH) after subcutaneous administration of bortezomib. SSH is a rare, characteristic cutaneous reaction that has been reported following intravenous administration of chemotherapeutic agents. Intravenous administration of bortezomib rarely results in documented cases of SSH. Subcutaneous injections of chemotherapeutic agents, including bortezomib, have not produced SSH.

This case is unique since subcutaneous administration of chemotherapeutic agents has never been reported to cause SSH. Additionally, bortezomib has not been reported as a common causative agent of this reaction.