Elastophagocytosis: A Clue to the Diagnosis of GM-CSF-Induced Dermatosis
Alicia D. Zalka, Anna Sarno
Ryan, Sophie M. Worobec, and Glynis A. Scott
Background:
Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a
cytokine used to stimulate the production of leukocytes and
monocytes 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-induced dermatoses, all of whom demonstrated enlarged
macro phages in the dermis. Biopsies from two of the patients
showed intracytoplasmic elastin fragments in dermal macro phages
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 the 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: Elastphagocytosis by
activated macrophages is a common finding in GM-CSF-induced
dermatoses and is a relatively specific clue to the diagnosis of
this disorder.
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