Iatrogenic systemic lymphedema following multiple myeloma treatment

Lymphedema is a debilitating disease characterized by abnormal lymphatic drainage, either due to primary maldevelopment ofthe lymphatic system or to secondary injury. The clinical features ofprimary and secondary lymphedema differ, with primary lymphedema more often involvingprogressive bilaterallower extremity disease as compared to secondary lymphedema characteristically havingmore localized symptoms related to the origin ofinjury. This case presentation describes a patient who presented with bilateral lower extremity swelling left greater than the right, with imaging results to support the diagnosis oflymphedema. During the time he was followed in our clinic, our team witnessed rapidprogression ofhislymphedema despite compliance with conservative management. We believe that the primary mechanism ofsystemic damage to our patient's lymphatic system is the lenalidomide and bortezomib therapyprescribed to treat multiple myeloma. This review explores the relationship between lenalidomide, bortezomib, and lymphedema in efforts of understanding this unique pathology ofiatrogenic lymphedema mimickingprimary nature.