A GENERALIZED CUTANEOUS REACTION INDUCED BY GRANULOCYTE-COLONY-STIMULATING FACTOR

Background: The increasing use of recombinant forms of granulocyte and granulocyte macrophage colony-stimulating factors (GCSF and GMCSF) fo r neutropenic conditions has resulted in reports of a variety of cutan eous reactions. Objective: We studied the clinical and histologic find ings in three patients who underwent bone marrow transplantation and s ubsequently had a cutaneous eruption associated with the use of GCSF. Methods: Biopsy specimens taken at the height of the eruption were stu died histologically and immunohistochemically. Results: The patients h ad indurated, well-demarcated, occasionally annular, erythematous papu les and plaques on the extremities that became generalized and cleared with fine desquamation after withdrawal of the medication. Distinctiv e histologic features consisted of mild epidermal spongiosis overlying a dermal infiltrate of enlarged, plump macrophages. Increased express ion of the vascular adhesion molecules ELAM-1 and VCAM-1, as well as t he keratinocyte-produced ICAM-1, was noted. Conclusion: The clinical a nd histologic findings of the cutaneous reaction to GCSF are character istic and allow its distinction from other eruptions that occur in bon e marrow transplant recipients.