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

• Yoon D
• Byun HJ
• Oh SJ
• Park JH
• Lee DY

• KMID: 2471345
• DOI: http://doi.org/10.5021/ad.2020.32.2.164

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.

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  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).

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