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Granulocyte-Macrophage Colony-Stimulating Factor in the Management of Severe Ecthyma Gangrenosum Related to Myelodysplastic Syndrome

Granulocyte-Macrophage Colony-Stimulating Factor in the Management of Severe Ecthyma Gangrenosum... Abstract REPORT OF A CASE A 78-year-old woman was admitted to the hospital for high fever (40°C) and severe neutropenia (3×109/L). The physical examination showed typical ecthyma gangrenosum on the elbow (Figure 1, top), with three metastatic cellulitic lesions on the thigh (Figure 1, bottom). In 1988, she was successfully treated by surgery and chemotherapy for colon adenocarcinoma. A myelodysplastic syndrome (refractory anemia) (medullar myeloblasts, 0.7) was diagnosed in 1989. The usual neutrophil count ranged from 2 to 4×109/L. With the progression of anemia, more erythrocyte transfusions were gradually required.Blood cultures and specimens taken from cutaneous punctures yielded Pseudomonas aeruginosa. The cultures and specimens featured similar resistance profiles and were responsive to the usual antibiotics for gram-negative pathogens. The initial site of infection remained unknown: no tumoral relapse was observed by colonoscopic examination, the urine cultures were sterile, and the ultrasonogram of the abdomen and the References 1. Souidi F, Chosidow 0, Cordonnier C, et al. Hematopoietic growth factors in treatment of necrotizing cellulitis patients with drug-induced neutropenia . Dermatology . 1993;187:71-72.Crossref 2. Musher DM. Cutaneous and soft-tissue manifestations of sepsis due to gramnegative enteric bacilli . Rev Infect Dis. 1980;2:854-865.Crossref 3. Boisseau AM, Sarlangue J, Perel Y, et al. Perineal ecthyma gangrenosum in infancy and early childhood . J Am Acad Dermatol. 1992;27:415-418.Crossref 4. Metcalf D. Control of granulocytes and macrophages . Science . 1991;254:529-533.Crossref 5. Ruef C, Coleman D. GM-CSF: pleiotropic cytokine with potential clinical usefulness . Rev Infect Dis. 1990;12:41-62.Crossref 6. Lieschke GJ, Burgess AW. G-CSF and GM-CSF . N Engl J Med. 1992;327:28-38.Crossref 7. Negrin RS, Haeuber DH, Nagler A, et al. Treatment of myelodysplastic syndromes with recombinant human granulocyte colony stimulating factor . Ann Intern Med. 1989;110:976-984.Crossref 8. Monroy R, Davis T, MacVittie T. Granulocyte-macrophage colony stimulating factor . Clin Immunol Immunopathol . 1990;54:333-346.Crossref 9. Johnson ML, Grimwood RE. Leukocyte colony-stimulating factors . Arch Dermatol. 1994;130:77-82.Crossref 10. Ariad S, Geffen D. Role of colony-stimulating factors during high dosage chemotherapy . Clin Immunother . 1994;1:449-459.Crossref 11. Schuster MW, Larson RA, Thompson JA. Granulocyte-macrophage colony stimulating factor for myelodysplastic syndrome . Blood . 1990;76( (suppl 1) ):318. 12. Quesenberry PJ, Rudnick S, Dale DC. Hematopoietic growth factors . In: Hematology 1991 . Washington, DC: American Society of Hematology; 1991. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Granulocyte-Macrophage Colony-Stimulating Factor in the Management of Severe Ecthyma Gangrenosum Related to Myelodysplastic Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690200026005
Publisher site
See Article on Publisher Site

Abstract

Abstract REPORT OF A CASE A 78-year-old woman was admitted to the hospital for high fever (40°C) and severe neutropenia (3×109/L). The physical examination showed typical ecthyma gangrenosum on the elbow (Figure 1, top), with three metastatic cellulitic lesions on the thigh (Figure 1, bottom). In 1988, she was successfully treated by surgery and chemotherapy for colon adenocarcinoma. A myelodysplastic syndrome (refractory anemia) (medullar myeloblasts, 0.7) was diagnosed in 1989. The usual neutrophil count ranged from 2 to 4×109/L. With the progression of anemia, more erythrocyte transfusions were gradually required.Blood cultures and specimens taken from cutaneous punctures yielded Pseudomonas aeruginosa. The cultures and specimens featured similar resistance profiles and were responsive to the usual antibiotics for gram-negative pathogens. The initial site of infection remained unknown: no tumoral relapse was observed by colonoscopic examination, the urine cultures were sterile, and the ultrasonogram of the abdomen and the References 1. Souidi F, Chosidow 0, Cordonnier C, et al. Hematopoietic growth factors in treatment of necrotizing cellulitis patients with drug-induced neutropenia . Dermatology . 1993;187:71-72.Crossref 2. Musher DM. Cutaneous and soft-tissue manifestations of sepsis due to gramnegative enteric bacilli . Rev Infect Dis. 1980;2:854-865.Crossref 3. Boisseau AM, Sarlangue J, Perel Y, et al. Perineal ecthyma gangrenosum in infancy and early childhood . J Am Acad Dermatol. 1992;27:415-418.Crossref 4. Metcalf D. Control of granulocytes and macrophages . Science . 1991;254:529-533.Crossref 5. Ruef C, Coleman D. GM-CSF: pleiotropic cytokine with potential clinical usefulness . Rev Infect Dis. 1990;12:41-62.Crossref 6. Lieschke GJ, Burgess AW. G-CSF and GM-CSF . N Engl J Med. 1992;327:28-38.Crossref 7. Negrin RS, Haeuber DH, Nagler A, et al. Treatment of myelodysplastic syndromes with recombinant human granulocyte colony stimulating factor . Ann Intern Med. 1989;110:976-984.Crossref 8. Monroy R, Davis T, MacVittie T. Granulocyte-macrophage colony stimulating factor . Clin Immunol Immunopathol . 1990;54:333-346.Crossref 9. Johnson ML, Grimwood RE. Leukocyte colony-stimulating factors . Arch Dermatol. 1994;130:77-82.Crossref 10. Ariad S, Geffen D. Role of colony-stimulating factors during high dosage chemotherapy . Clin Immunother . 1994;1:449-459.Crossref 11. Schuster MW, Larson RA, Thompson JA. Granulocyte-macrophage colony stimulating factor for myelodysplastic syndrome . Blood . 1990;76( (suppl 1) ):318. 12. Quesenberry PJ, Rudnick S, Dale DC. Hematopoietic growth factors . In: Hematology 1991 . Washington, DC: American Society of Hematology; 1991.

Journal

Archives of DermatologyAmerican Medical Association

Published: Aug 1, 1995

References