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) for neutropenic conditions has resulted in reports of a variety of cutaneous reactions. Objective: We studied the clinical and histologic findings in three patients who underwent bone marrow transplantation and subsequently had a cutaneous eruption associated with the use of GCSF. Methods: Biopsy specimens taken at the height of the eruption were studied histologically and immunohistochemically. Results: The patients had indurated, well-demarcated, occasionally annular, erythematous papules and plaques on the extremities that became generalized and cleared with fine desquamation after withdrawal of the medication. Distinctive histologic features consisted of mild epidermal spongiosis overlying a dermal infiltrate of enlarged, plump macrophages. Increased expression of the vascular adhesion molecules ELAM-1 and VCAM-1, as well as the keratinocyte-produced ICAM-1, was noted. Conclusion: The clinical and histologic findings of the cutaneous reaction to GCSF are characteristic and allow its distinction from other eruptions that occur in bone marrow transplant recipients.