M Sai Bindu
Self, India
Abstract Title: A rare case of Pityriasis Lichenoides Chronica in a elderly male secondary to multiple myeloma or is it drug induced? : A case report
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Introduction: Pityriasis Lichenoides Chronica (PLC) is a rare skin disorder characterized by small, scaling papules that can become necrotic and evolve into larger eroded or crusted lesions. While the etiology of PLC remains unclear,It has been postulated to be a response to foreign antigens such as infectious agents and drugs. A few reports describe its association with specific infections (e.g. HIV, parvovirus B19), medications (e.g. estrogen–progesterone, TNF-α inhibitors [infliximab, adalimumab], statins), and radiocontrast dye. This report aims to discuss the onset of PLC in a patient undergoing treatment for Multiple Myeloma with the VRD regimen.
Case Detail: A 66-year-old male diagnosed with Multiple Myeloma 7 months ago is undergoing treatment with the VRD (Bortezomib, Lenalidomide, Dexamethasone) regimen which was initiated on 5/4/23 and was on cycle 3 week 4 on 22/6/23. Patient is a known case of hypertension and diabetes and is on amlodipine 5 mg and combination of Glimepiride+Metformin Hydrochloride 1mg/500mg respectively since 9 years.He presented to dermatology on 22/6/23 with a 4-day history of pruritic, scaling lesions predominantly on his trunk, extending to extremities. Clinical assessment multiple erythematous plaques with micaceous scales centrally attached and peripherally free present over the chest periumbilical area, back and extremities. Histopathological examination was consistent diagnosis of PLC.
Discussion: PLC is a cutaneous lymphoproliferative disease. Classically, PLC emerges as a gradual influx of erythematous to reddish-brown papules, predominantly afflicting the trunk or proximal extremities. A distinguishing feature is the central brownish, adherent micaceous scale on these papules.While PLC's pathogenesis is not entirely understood, it has been linked to hypersensitive reactions to various triggers. The onset of PLC in this patient undergoing treatment for Multiple Myeloma with VRD highlights the need to consider possible drug-induced PLC. The VRD regimen, especially Bortezomib, is known to cause cutaneous side effects, however PLC has not been widely reported and existing scales donot show significant temporal relation with the mentioned drugs.
Conclusion: Patients with Multiple Myeloma on VRD therapy can manifest with various skin changes. While drug-induced PLC is a rare occurrence, it should be considered in the differential diagnosis. A multidisciplinary approach involving both dermatology and oncology department can ensure accurate diagnosis and optimal management of both the skin condition and the underlying malignancy.