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.
Conclusion: 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.