Granulomatous Dermatitis with Enlarged Histiocytes: A Characteristic Pattern of Granulocyte Colony-Stimulating Factor

Abstract

Two patients developed a pruritic maculopapular rash following treatment with granulocyte colony-stimulating factor (G-CSF). Histopathological examination disclosed a superficial dermal inflammatory infiltrate composed of interstitially arranged large histiocytic CD68+ cells and perivascularly disposed lymphocytes. Large histiocytes were interspersed among the collagen bundles with associated slight deposits of mucin. Elastophagocytosis was occasionally observed, and a slight reduction of dermal elastic fibers was also noted. There was no evidence of frank granuloma formation, fibrosis or significant changes of collagen bundles. This histopathological variant of granulomatous dermatitis with ‘enlarged histiocytes’ seems to be characteristic of an unusual cutaneous reaction secondary to CSF treatment.

Cutaneous Reactions to Novel Therapeutics

“…44 Cutaneous side effects can be diffuse eruption [45][46][47][48][49][50][51][52] or reaction at injection site. 53,54 Skin biopsies often show an increase in the number of dermal macrophages, often enlarged in size.…”

Interstitial granulomatous drug reaction to anakinra

“…9 Interstitial granulomatous dermatitis without arthritis has also been reported in response to granulocyte colonyestimulating factor. 10 The negative systemic work-up and the resolution of the lesions upon withdrawal of the drug were crucial in ruling out leukemia cutis.…”

Granulocyte colony‐stimulating factor‐induced granulomatous dermatitis with enlarged histiocytes clinically manifesting as painful edematous nodules with high fever similar to Sweet's syndrome

“…Skin biopsy specimens taken from two of the eruptions displayed characteristic changes consisting of a variable mixture of granulocytes and lymphocytes, and an increased number and size of dermal macrophages. Since the report by Horn et al ., several cases have been reported with this histological alteration, which is viewed as a characteristic reaction to these cytokines . Ferran et al .…”

“…Granulocyte colony‐stimulating factor (G‐CSF) and granulocyte and macrophage colony‐stimulating factor are cytokines that stimulate the proliferation of hematopoietic progenitor cells, especially the granulocytic lines including neutrophils . These cytokines are commonly used in the treatment of chemotherapy‐induced myelosuppression.…”

“…These cytokines are commonly used in the treatment of chemotherapy‐induced myelosuppression. A wide range of cutaneous eruptions secondary to this treatment have been reported including local reactions at the site of injection, specific cutaneous disorders, and non‐specific maculopapular eruptions . In 1991, Horn et al .…”