Ann Dermatol.  2020 Apr;32(2):164-167. 10.5021/ad.2020.32.2.164.

A Case of Cutaneous Leukocytoclastic Vasculitis Associated with Granulocyte Colony-Stimulating Factor: An Unusual Presentation

Affiliations
  • 1Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jh1204.park@samsung.com

Abstract

Drug-induced vasculitis is an inflammation of small-sized blood vessel caused by the use of drugs. It accounts for approximately 10% of acute cutaneous vasculitis. Propylthiouracil, hydralazine, and allopurinol have been widely known as causative agents. The most common clinical feature of drug-induced vasculitis is palpable purpura on lower extremities. A 66-year-old Korean female presented with erythematous nodules on upper chest and back. She had been on medication for multiple myeloma. Laboratory results showed neutropenia. After a single injection of filgrastim (recombinant granulocyte colony-stimulating factor), she developed cutaneous lesions with concurrent increase in absolute neutrophil count. A skin biopsy revealed leukocytoclastic vasculitis. After discontinuation of filgrastim injection, her skin lesions disappeared spontaneously.

Keyword

Cutaneous; Cutaneous small vessel; Granulocyte colonystimulating factor; Skin; Vasculitis

MeSH Terms

Aged
Allopurinol
Biopsy
Blood Vessels
Female
Filgrastim
Granulocyte Colony-Stimulating Factor*
Granulocytes*
Humans
Hydralazine
Inflammation
Lower Extremity
Multiple Myeloma
Neutropenia
Neutrophils
Propylthiouracil
Purpura
Skin
Thorax
Vasculitis
Vasculitis, Leukocytoclastic, Cutaneous*
Allopurinol
Filgrastim
Granulocyte Colony-Stimulating Factor
Hydralazine
Propylthiouracil

Figure

  • Fig. 1 Multiple tender finger-tip to coin sized red colored nodules on her upper chest (A) and back (B). We received the patient's consent form about publishing all photographic materials.

  • Fig. 2 Histopathological images of skin biopsy. (A) Perivascular inflammatory cells infiltration in the upper dermis (H&E, ×40). (B) Vessel destruction, fibrinoid necrosis, and neutrophils and lymphocytes infiltration (H&E, ×400).


Reference

1. White JM, Mufti GJ, Salisbury JR, du Vivier AW. Cutaneous manifestations of granulocyte colony-stimulating factor. Clin Exp Dermatol. 2006; 31:206–207. PMID: 16487091.
Article
2. Ross HJ, Moy LA, Kaplan R, Figlin RA. Bullous pyoderma gangrenosum after granulocyte colony-stimulating factor treatment. Cancer. 1991; 68:441–443. PMID: 1712666.
Article
3. Cottle TE, Fier CJ, Donadieu J, Kinsey SE. Risk and benefit of treatment of severe chronic neutropenia with granulocyte colony-stimulating factor. Semin Hematol. 2002; 39:134–140. PMID: 11957197.
Article
4. Ippoliti G, Paulli M, Lucioni M, Lauriola M, D'Armini AM. Leukocytoclastic vasculitis as a complication of recombinant granulocyte colony-stimulating factor therapy in a heart transplant patient. Case Rep Transplant. 2014; 2014:160407. PMID: 24600524.
Article
5. El Husseiny NM, Mattar MM. Aggressive cutaneous vasculitis in a patient with chronic lymphatic leukemia following granulocyte colony stimulating factor injection: a case report. J Med Case Rep. 2011; 5:88. PMID: 21362198.
Article
6. Kilic SS, Mustafayeva S, Ipek K, Adim SB. Leukocytoclastic vasculitis in patients with severe congenital neutropenia. J Trop Pediatr. 2010; 56:359–362. PMID: 20100783.
Article
7. Andavolu MV, Logan LJ. Leukocytoclastic vasculitis as a complication of granulocyte colony-stimulating factor (G-CSF) -- a case study. Ann Hematol. 1999; 78:79–81. PMID: 10089022.
Article
8. Jain KK. Cutaneous vasculitis associated with granulocyte colony-stimulating factor. J Am Acad Dermatol. 1994; 31(2 Pt 1):213–215. PMID: 7518847.
Article
9. Ito Y, Noda K, Aiba K, Yano S, Fujii T. [Diffuse large B-cell lymphoma complicated with drug-induced vasculitis during administration of pegfilgrastim]. Rinsho Ketsueki. 2017; 58:2238–2242. Japanese. PMID: 29212975.
10. Elsner J, Roesler J, Emmendörffer A, Zeidler C, Lohmann-Matthes ML, Welte K. Altered function and surface marker expression of neutrophils induced by rhG-CSF treatment in severe congenital neutropenia. Eur J Haematol. 1992; 48:10–19. PMID: 1370419.
Article
11. Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw Hill;2012. p. 456.
12. Goeser MR, Laniosz V, Wetter DA. A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. Am J Clin Dermatol. 2014; 15:299–306. PMID: 24756249.
Article
Full Text Links
  • AD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr