Bortezomib-induced severe autonomic neuropathy

Abstract

Peripheral neuropathy is a known side effect of bortezomib therapy. Acute autonomic neuropathy may also follow treatment with this cytotoxic agent used for treatment of multiple myeloma. Here, we report clinical characteristics and patterns of autonomic involvement in a 75-year-old patient who presented with recurring syncopes.

Chemotherapy‐induced peripheral neurotoxicity: A critical analysis

“…Bortezomib‐induced peripheral neuropathy is predominantly sensory, with paresthesia and numbness occurring in distal areas, particularly lower limbs . In contrast to other CIPNs, bortezomib‐induced neuropathy involves prominent small fiber involvement, characterized by sharp, burning pain in the toes and soles of the feet . Autonomic involvement may develop, including orthostatic hypotension, suppressed heart rate variability, and delayed gastric emptying, but motor involvement is uncommon .…”

“…In contrast to other CIPNs, bortezomib‐induced neuropathy involves prominent small fiber involvement, characterized by sharp, burning pain in the toes and soles of the feet . Autonomic involvement may develop, including orthostatic hypotension, suppressed heart rate variability, and delayed gastric emptying, but motor involvement is uncommon . Typically, 10% of patients must discontinue bortezomib treatment due to neuropathic symptoms .…”

Small‐fiber neuropathy with cardiac denervation in postural tachycardia syndrome

“…Protein Gene Product 9.5 (PGP9.5) immunohistochemistry of skin biopsies has emerged as a valuable tool to analyze autonomic innervation morphologically . The loss of autonomic nerve fibers was shown in Ross syndrome and in familial dysautonomia (Riley–Day syndrome) and other peripheral neuropathies . Measurement of intraepidermal axon density is now used to diagnose neuropathies and to assess the distribution and severity of denervation .…”

“…11,12 The loss of autonomic nerve fibers was shown in Ross syndrome and in familial dysautonomia (Riley-Day syndrome) 13 and other peripheral neuropathies. [14][15][16][17][18][19][20][21][22][23][24][25] Measurement of intraepidermal axon density is now used to diagnose neuropathies and to assess the distribution and severity of denervation. 26 In a study of a small group of 8 POTS patients, intraepidermal nerve fiber (IENF) density was in the normal range, but 3 of the 8 had some morphological abnormalities, including bulbous swelling of intraepidermal unmyelinated fibers.…”

Systemic Amyloidosis and Cardiac Autonomic Neuropathy Associated with Waldenstrom’s Macroglobulinemia

“…36% of these patients have cardiac involvement. Clinical findings of amyloid cardiomyopathy are found in 50 percent of patients with AL amyloidosis, while only under 5% of AA amyloidosis patients develop this [8, 9]. Senile amyloidosis (ATTR) can result in predominantly infiltrative cardiomyopathy.…”