A Case of Cutaneous Leukocytoclastic Vasculitis Associated with Granulocyte Colony-Stimulating Factor: An Unusual Presentation

Abstract

Drug-induced vasculitis is an inflammation of small-sized blood vessel caused by the use of drugs. It accounts for approximately 10% of acute cutaneous vasculitis. Propylthiouracil, hydralazine, and allopurinol have been widely known as causative agents. The most common clinical feature of drug-induced vasculitis is palpable purpura on lower extremities. A 66-year-old Korean female presented with erythematous nodules on upper chest and back. She had been on medication for multiple myeloma. Laboratory results showed neutropenia. After a single injection of filgrastim (recombinant granulocyte colony-stimulating factor), she developed cutaneous lesions with concurrent increase in absolute neutrophil count. A skin biopsy revealed leukocytoclastic vasculitis. After discontinuation of filgrastim injection, her skin lesions disappeared spontaneously.

Balancing Benefits and Risks: A Literature Review on Hypersensitivity Reactions to Human G-CSF (Granulocyte Colony-Stimulating Factor)

“…From a dermatological standpoint, G-CSF therapy has been linked to various manifestations, such as pyoderma gangrenosum [58], Sweet's syndrome [59][60][61][62][63][64][65], other neutrophilic dermatoses [66], granulomatous dermatitis [67], widespread folliculitis [68], cutaneous vasculitis [50,[69][70][71][72], and exacerbations of acne [73] and psoriasis [70,74,75]. Several cases of cutaneous eruptions containing leukemic cells have been reported (without their presence in the bone marrow or blood) after G-CSF, suggesting the skin's ability to simulate malignancies, as well as its dependency on G-CSF administration [76,77].…”

Development of papulonodular eruptions in a patient with granulocyte colony‐stimulating factor‐induced leukocytoclastic vasculitis: A case report

“…A cutaneous manifestation, such as papulonodular eruptions, is unusual for LV, with the exception of erythema elevatum diutinum, which may occur in association with hematologic diseases and malignancies 9 . However, multiple nodules associated with LV have been reported in a multiple myeloma patient receiving G‐CSF, 10 and the spontaneous healing after the cessation of lenograstim indicated that erythema elevatum diutinum could be excluded. A high immunoglobulin level was regarded as one of the predisposing factors for LV 3 .…”