title: A generalized cutaneous reaction induced by granulocyte colony-stimulating factor.
abstract: 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 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 histologic keratinocyte-produced ICAM-1, was noted.
  
  
  CONCLUSIONS
  the clinical and histological findings of the cutaneous reaction to GCSF are characteristic and allow its distinction from other eruptions that occur in bone marrow transplant recipients.
authors.affiliation: Department of Medicine, University of South Florida College of Medicine, Tampa, USA.
authors.forename: L F
authors.initials: LF
authors.lastname: Glass
authors.forename: T
authors.initials: T
authors.lastname: Fotopoulos
authors.forename: J L
authors.initials: JL
authors.lastname: Messina
mesh_terms: D000328:Adult; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D001943:Breast Neoplasms / Q000628:therapy; D002277:Carcinoma / Q000628:therapy; D019040:E-Selectin / Q000032:analysis; D004817:Epidermis / Q000473:pathology; D004890:Erythema / Q000473:pathology; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects*; D006689:Hodgkin Disease / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D015603:Keratinocytes / Q000473:pathology; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008264:Macrophages / Q000473:pathology; D008875:Middle Aged; D009503:Neutropenia / Q000628:therapy; D011994:Recombinant Proteins; D017444:Skin Diseases, Papulosquamous / Q000209:etiology* / Q000473:pathology; D019010:Vascular Cell Adhesion Molecule-1 / Q000032:analysis
chemical_list: D019040:E-Selectin; D011994:Recombinant Proteins; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D016179:Granulocyte Colony-Stimulating Factor