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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