In the last years, granulocyte and granulocyte-macrophage colony-stimulating factors (G-CSF and GM-CSF) are being increasingly used and several cutaneous eruptions have been reported in relation to these treatments. In 1991 Horn et al. described three patients with maculopapular eruption that paralleled the time of infusion of GM-CSF. Two of the cases showed an increase in the number and size of macrophages in the biopsy specimen. Since then, several cases have been reported showing this histopathological alteration that has been considered characteristic of reaction to G-CSF or GM-CSF. Although maculopapular eruption with enlarged macrophages can appear after chemotherapy treatment, we have found that the presentation of this eruption after the beginning of cytokine treatment is suggestive of the involvement of G-CSF and GM-CSF in the eruption. We described eight cases of patients treated with G-CSF or GM-CSF that developed maculopapular eruptions with enlarged macrophages.

We report a patient with multiple myeloma associated with primary systemic amyloidosis who had a rapid evolution and a very unusual form of presentation. The association of amyloidosis in patients with multiple myeloma is 15%, and clinically evident mucocutaneous involvement occurs in up to 40% of patients.

Low back pain is the most frequent rheumatologic manifestation of brucellosis. The diagnosis of brucellar sacroiliitis is hampered by the poor specificity of the clinical data and the p r sensitivity of the radidogic data. In this report, we show that scintigraphy not only increases the sensitivity but also allows an earlier diagnosis of disease and permits the detection of osteoarticular brucellar involvement in areas adjacent to the sacroiliac joint.

type VIN were strongly reactive to p16INK4 with a mean score of 5.5 (range 4-6, median ¼ 6), supporting their association with HPV ( Figure 1D).It is now generally accepted that there are at least two type of vulvar intraepithelial neoplasia (VIN): classic type VIN and simplex type VIN. Classic VIN is associated with HPV infection. 8 Currently, it is believed that simplex VIN is rarely associated with HPV infection. 4 In simplex VIN, p53 positive cells are often present above the basal cell layer whereas in classic VIN this does not occur. 4 Simplex VIN is also more frequently associated with well differentiated invasive squamous cell carcinoma.All of our classic VIN cases are strongly immunopositive with p16INK4 whereas 90% of our simplex VIN cases showed no reactivity to p16INK4 antibody. The remaining two cases exhibited focal weak positivity which may be considered negative in clinical practice, so that all of our classic VIN are positive and 100% of our simplex VIN are negative for p16INK4. Our study suggests that the immunohistochemical staining pattern of simplex VIN could thus be characterized as p16INK4 negative with p53 positive cells above the basal layer of the epidermis whereas classic warty type VIN is p16INK4 positive but negative for p53 in the supra-basilar layers.Our results affirm the current supposition that simplex VIN is usually a non-HPV-related lesion. Because of the higher rate of conventional invasive squamous cell carcinoma associated with simplex VIN, our findings support the premise that simplex VIN serves as a precursor to non-HPV-related invasive well differentiated squamous cell carcinoma of the vulva.

S . B . Á l v a r e z -R u i z I . G a r c í a -R í o M . A r a g ü é s J . F r a g a * J . L o c e r t a l e s P u e y o J . F e r n á n d e z -H e r r e r a A . G a r c í a -D í e z