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Systemic lymphadenopathy with systemic sclerosis and Sjögren's syndrome: A case report

patients as a result of the inhibition of NF-jB, resulting in enhanced apoptosis. Bortezomib-associated rash (BAR) is common with incidence rates reported in clinical trials ranging 8–40%. The types of rashes reported include: drug hypersensitivity, vasculitis, Sweet’s syndrome and lupus erythematosus tumidis. BAR is usually asymptomatic and not associated with constitutional symptoms. It usually resolves with systemic corticosteroids and the severity generally does not lead to modification of treatment regimen. In animal models with lupus-like disease, bortezomib has been shown to deplete autoreactive plasma cells and serum autoantibody levels and may be a potentially new treatment strategy for systemic lupus erythematosus and other antibodymediated diseases. Although there is a reported association between myeloma and lupus, our patient only presented with a lupus rash after bortezomib was commenced. Whilst BAR is common, we believe the diagnosis of lupus in our patient was confirmed by the clinical, histological and serological findings. On literature review, no other proteasome inhibitors have been associated with causing cutaneous lupus. To our knowledge, this is the first reported case of cutaneous lupus relapsing while on bortezomib treatment and suggests a potential paradoxical side-effect of the drug. This needs to be confirmed by other similar reports.