No abstract

No abstract

No abstract

No abstract

occurred as a result of recombinant DNA technology. Granulocyte-macrophage-eolony-stimulating factor has a primary role in the hematopoietic maturation of cells that become granulocytes and monocytes.12Although granulocyte-macrophage-colony-stimulating factor was reported to exacerbate a paraneoplastic vascu¬ litis in a patient with small-cell lung cancer/ this is the first example of a vasculitis occurring at granulocyte-macrophage-colony-stimulating factor injection sites. Although ciprofloxacin has been reported as an inducer of vasculitis,6 and our patient first developed an eruption while receiving this drug, no cutaneous reaction to ciprofloxacin occurred after re-challenge. Interestingly, this patient was able to mount a vasculitis with polymorphonuclear leukocytes at granulocyte-macrophage-colony-stimulating factor injection sites in the face of profound neutropenia. The mechanism could in¬ clude granulocyte-macrophage-colony-stimulating factor chemotaxis of polymorphonuclear leukocytes to injection sites, nonspecific activation of polymorphonuclear leuko¬ cyte or antigen-presenting cells, or potentiation of a druginduced vasculitis. However, vasculitis has not been ob¬ served in over 150 other neutropenic patients receiving granulocyte-macrophage-colony-stimulating factor at our institution. Therefore, pure white-cell aplasia with possible autoimmune pathogenesis may have contributed, and these patients may need to be monitored for vasculitis if they are to receive granulocyte-macrophage-colony-stimulating factor therapy.