REPORT OF 3 CASES OF CUTANEOUS REACTIONS TO GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR AND A REVIEW OF THE LITERATURE

Granulocyte macrophage-colony-stimulating factor (GMCSF) is a cytokine used to stimulate the growth and maturation of granulocytes and macro phages in a variety of clinical settings. Reported cutaneous side effe cts of GMCSF therapy include both local reactions at the site of injec tion and diffuse eruptions. In this report we describe the clinical an d histologic features of three patients who had a widespread macular-p apular eruption after GMCSF therapy to stimulate bone marrow recovery. In all three patients the eruptions occurred within 3 days of startin g GM-CSF therapy and resolved after the infusion ended. Histologic fea tures of the eruptions included a mixed infiltrate of lymphocytes, eos inophils, and neutrophils, primarily in the papillary dermis. In all t hree cases there was an increase in the number of dermal macrophages, and in two cases there was a striking increase in the size of dermal m acrophages, many of which contained ingested elastin. We report these cases to alert the reader that alteration in number or size of dermal macrophages is a clue to the diagnosis of GM-CSF-induced dermatoses. A review of the literature of cutaneous side effects of GM-CSF is inclu ded.