title: Case report: granulocyte colony-stimulating factor overcomes severe neutropenia of large granular lymphocytosis.
abstract: Large granular lymphocytosis (LGL) is characterized by enhanced proliferation of T lymphocytes that have antibody-dependent cell-mediated cytotoxicity or natural killer cell activity and that often produce severe cytopenias, including neutropenia. When a 68-year-old man with seropositive rheumatoid arthritis and severe neutropenia was examined, he was found to have LGL with a T cell gene rearrangement, indicating the presence of a clonal population of T lymphocytes. The patient was admitted with a fever of 102 degrees F and a nonhealing ulcer over the right tibia. When the infection did not respond to intravenous antibiotics, granulocyte colony-stimulating factor (GCSF) therapy was started at 5 micrograms/kg subcutaneously each day. The neutrophil count promptly increased and the patient subsequently defervesced and was able to have a skin graft placed, which healed without difficulty. GCSF, which is known to be an effective therapeutic agent for neutropenia associated with chemotherapy and bone marrow transplantation, also was a very valuable treatment for the life-threatening neutropenia of LGL.
mesh_terms: D000368:Aged; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007694:Killer Cells, Natural / Q000166:cytology; D008218:Lymphocytosis / Q000188:drug therapy*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy*; D013601:T-Lymphocytes / Q000166:cytology
chemical_list: D016179:Granulocyte Colony-Stimulating Factor