Linear IgA bullous dermatosis in a patient with acute lymphocytic leukemia: possible involvement of granulocyte colony-stimulating factor

We describe a case of linear IgA bullous dermatosis (LABD) in a patient wit h acute lymphocytic leukemia during treatment with granulocyte colony-stimu lating factor (G-CSF). After a drug eruption due to imipenem cilastatin sod ium had disappeared, bullous lesions appeared on the trunk. Results of hist opathological studies and direct immunofluorescence studies of the lesion w ere consistent with LABD. Reinstitution of G-CSF after the resolution howev er did not reproduce the bullous eruptions. This suggests that in addition to G-CSF, the presence of precipitating factors that can synergistically en hance or accelerate the outbreak of the disease is required for the develop ment of bullous lesions. Various cytokines, such as interleukin-2 (IL-2) an d interferon-gamma (IFN-gamma), endogenously produced from activated lympho cytes during the drug eruption might have provided a favorable milieu for t he onset of G-CSF-induced LABD. We suggest that patients with LABD will nee d special attention with respect to the type of cytokines or combination of cytokines given as therapeutic modalities.