Oculomotor nerve palsy associated with bortezomib in a patient with multiple myeloma: a case report

Bassem Toema, Hamdan El-Sweilmeen, Tarek Helmy

Bortezomib is a proteasome inhibitor used in the treatment of multiple myeloma. A newly recognized oculomotor nerve palsy related to bortezomib is described. A 54-year-old Caucasian woman with immunoglobulin G kappa multiple myeloma on single-agent bortezomib given by intravenous push once weekly developed isolated unilateral partially reversible left sided oculomotor nerve palsy during the first cycle of treatment. All the essential diagnostic tests that were carried out excluded all other possible causes. There was a positive dechallenge-rechallenge test. Management was by withdrawal of bortezomib and empirical dexamethazone. To the best of our knowledge, this is the first report of its kind in the literature. This case illustrates the probable association between oculomotor nerve palsy and bortezomib, and generates a hypothesis of whether bortezomib can cross the blood-brain barrier or not.