Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2905-2909
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2905
Guillain-Barré syndrome in a patient with multiple myeloma after bortezomib therapy: A case report
Yu-Ling Xu, Wei-Hua Zhao, Zhong-Yuan Tang, Zhong-Qing Li, Yuan Long, Peng Cheng, Jun Luo
Yu-Ling Xu, Wei-Hua Zhao, Zhong-Yuan Tang, Zhong-Qing Li, Yuan Long, Peng Cheng, Jun Luo, Department of Hematology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Xu YL wrote and revised the manuscript; Zhao WH and Tang ZY collected the clinical data; Li ZQ, Long Y, and Cheng P provided information consultation; Luo J reviewed the manuscript; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81660038.
Informed consent statement: Informed consent was obtained from the patient for this publication.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Luo, PhD, Chief Doctor, Professor, Department of Hematology, the First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. luojungz@medmail.com.cn
Telephone: +86-13877179705
Received: April 11, 2019
Peer-review started: April 12, 2019
First decision: August 1, 2019
Revised: August 13, 2019
Accepted: August 26, 2019
Article in press: August 26, 2019
Published online: September 26, 2019
Processing time: 166 Days and 22.2 Hours
Abstract
BACKGROUND

Bortezomib is a first-line drug approved for patients with multiple myeloma (MM) and has significantly increased their overall survival. However, bortezomib-induced peripheral neuropathy (PN) remains a significant side effect that has led to its discontinuation in some patients. Guillain-Barré syndrome (GBS) is recognized as an immune-mediated PN characterized by the involvement of multiple nerve roots and peripheral nerves and albuminocytologic dissociation in cerebrospinal fluid (CSF) tests. Intravenous immunoglobulin (IVIG) and plasmapheresis are effective.

CASE SUMMARY

A 45-year-old man diagnosed with stage III MM (λ type) was treated with bortezomib and dexamethasone. Fourteen days after the second course, he complained of intense burning sensation in the lower limbs and hands, loss of tactile sensation, and pain in the distal area of both thighs and in the distal part of both wrist joints. Neurological examination revealed absence of knee and ankle reflexes. CSF examination revealed albuminocytologic dissociation. Nerve conduction studies indicated sensory nerve action potential amplitudes, conduction velocity decrease, and F wave latency prolongation. He was diagnosed as MM complicated with GBS. Subsequently, he was treated with high-dose IVIG (400 mg/kg/d for five days). His symptoms fully resolved without relapse at the 6-month follow-up.

CONCLUSION

Our case highlights the differential diagnosis and management of complications after bortezomib treatment in MM.

Keywords: Case report; Guillain-Barré syndrome; Multiple myeloma; Bortezomib

Core tip: Multiple myeloma (MM) is a malignant clonal disease, which shortens the survival time of the patients. Bortezomib, a first-line drug for the treatment of MM, has prolonged patient survival. Therefore, the adverse reactions have become a hot topic. We can have a better understanding of its complications and treatment through this case.