Maculopapular eruption with enlarged macrophages in eight patients receiving G‐CSF or GM‐CSF

Abstract

In the last years, granulocyte and granulocyte-macrophage colony-stimulating factors (G-CSF and GM-CSF) are being increasingly used and several cutaneous eruptions have been reported in relation to these treatments. In 1991 Horn et al. described three patients with maculopapular eruption that paralleled the time of infusion of GM-CSF. Two of the cases showed an increase in the number and size of macrophages in the biopsy specimen. Since then, several cases have been reported showing this histopathological alteration that has been considered characteristic of reaction to G-CSF or GM-CSF. Although maculopapular eruption with enlarged macrophages can appear after chemotherapy treatment, we have found that the presentation of this eruption after the beginning of cytokine treatment is suggestive of the involvement of G-CSF and GM-CSF in the eruption. We described eight cases of patients treated with G-CSF or GM-CSF that developed maculopapular eruptions with enlarged macrophages.

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.…”

Drug-induced cutaneous pathology

“…It is caused by chronic drug consumption, ranging from 4 weeks to 25 years (average, 5 years) 71. The eruption resolves within 1 to 40 weeks (average, 8 weeks) after discontinuation of the offending drug 71.…”

“…It is caused by chronic drug consumption, ranging from 4 weeks to 25 years (average, 5 years) 71. The eruption resolves within 1 to 40 weeks (average, 8 weeks) after discontinuation of the offending drug 71. The drug groups implicated include calcium channel blockers, ACE inhibitors, β blockers, diuretics, NSAIDs, lipid-lowering drugs, anticonvulsants, antihistamines, antidepressants, herbal medications and four different anti-TNFs 71 – 78.…”

“…The eruption resolves within 1 to 40 weeks (average, 8 weeks) after discontinuation of the offending drug 71. The drug groups implicated include calcium channel blockers, ACE inhibitors, β blockers, diuretics, NSAIDs, lipid-lowering drugs, anticonvulsants, antihistamines, antidepressants, herbal medications and four different anti-TNFs 71 – 78. The underlying pathogenesis may be related to an immune complex disorder and subsequent ischaemia and collagen alterations 69 – 71.…”

Cytokines Induced Skin Adverse Reactions

“…It seems that GM-CSF produced more frequent injection-site reactions and skin rash. Although it is not known how the administration of the recombinant human cytokine in pharmacologic doses results in the expression of a cutaneous eruption, there are some clues that it could induce changes in the immunologic status of the skin [44]. Patients should be monitored for development of inflammatory processes during G-CSF or GM-CSF therapy and this therapy should be given with caution to those patients with existing inflammatory conditions.…”