Proliferation of abnormal bone marrow histiocytes, an undesired effect of granulocyte macrophage-colony-stimulating factor therapy in a patient with Hurler's syndrome undergoing bone marrow transplantation

Elastophagocytosis: A Clue to the Diagnosis of GM-CSF-Induced Dermatosis

Background:

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine used to stimulate the production of leukocytes and monocytes in neutropenic patients. Cutaneous reactions to GM-CSF are relatively common. However, documentation of the histologic features of GM-CSF-induced dermatoses has only been reported in nine patients. We previously reported three patients with GM-CSF dermatoses, all of whom demonstrated enlarged macrophages in the dermis. Biopsies from two of the patients showed intracytoplasmic elastin fragments in dermal macrophages consistent with GM-CSF's documented ability to increase phagocytic activity of macrophages in vitro.

Objective:

The objective of the present report is to present an additional case of GM-CSF-induced dermatoses and to document the apparent ability of this cytokine to induce phagocytosis of elastin fragments by macrophages.

Methods and Results:

The patient received GM-CSF to stimulate bone marrow recovery after a bone marrow transplant. He developed a diffuse macular papular rash that on biopsy revealed enlarged dermal macrophages with prominent intracytoplasmic elastin fragments.

Conclusions:

Elastophagocytosis by activated macrophages is a common finding in GM-CSF-induced dermatoses and is a relatively specific clue to the diagnosis of this disorder.