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Leukocytoclastic Vasculitis as a Complication of Recombinant Granulocyte Colony-Stimulating Factor Therapy in a Heart Transplant Patient

DOI: 10.1155/2014/160407

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Abstract:

Recombinant granulocyte colony-stimulating factor (rG-CSF) is a myeloid growth factor that is widely used in haematology to recover neutropenia secondary to myelosuppressive chemotherapy. Leukocytoclastic vasculitis is an acknowledged side effect of the above therapy. Its pathogenesis involves many mechanisms that collectively induce an increase in neutrophil function and a subsequent release of cytokines. Here, we report a case of leukocytoclastic vasculitis proven by skin biopsy, following the use of rG-CSF in a heart transplant patient with leukopenia secondary to immunosuppressive therapy. 1. Introduction Vasculitis is an inflammation of the blood vessel wall that leads to various clinical manifestations, depending on which organ system is involved. Cutaneous vasculitis is a histopathologic entity that is characterized by neutrophilic transmural inflammation of the vessel wall and is associated with fibrinoid necrosis, which is also termed leukocytoclastic vasculitis. Vasculitis has a wide spectrum of severity, ranging from skin-limited disease to life-threatening systemic involvement [1]. rG-CSF (filgrastim) is a myeloid growth factor produced by monocytes, macrophages, fibroblasts, and endothelial cells. The clinical use of rG-CSF includes recovery from neutropenia in patients receiving myelosuppressive chemotherapy for solid as well as hematologic malignancies; management of neutropenia deriving from other causes such as AIDS, genetic disorders in granulocyte production and, mobilization of peripheral blood progenitor cells [2, 3]. Some side effects have been reported for rG-CSF treatment: they are usually mild and they include bone pain, headache, and fatigue [3, 4]. Below, we report a case of leukocytoclastic vasculitis that occurred during rG-CSF treatment in a heart transplant patient. 2. Case Report A 35-year-old man was admitted to our hospital because of leukopenia and anaemia. The patient had undergone heart transplantation (H-Tx) two months previously on account of dilated cardiomyopathy. After H-Tx, immunosuppression consisted in rabbit antithymocyte globulin (RATG) for three days (in doses that were regularly adjusted on the basis of absolute CD3+ T lymphocytes count), cyclosporine A, azathioprine, and steroids. No acute rejection episodes or infectious or autoimmune diseases were observed during followup. At admission, the patient was on cyclosporin A (CyA:?trough levels: 200? g/l), azathioprine (AZA: 100?mg/d), and steroids (5?mg/d). Laboratory data showed WBC /mcl, neutrophils /mcl, Hb g/dL, and platelets /mcl. Renal, hepatic, and

References

[1]  S. J. Jessop, “Cutaneous leucocytoclastic vasculitis: a clinical and aetiological study,” British Journal of Rheumatology, vol. 34, no. 10, pp. 942–945, 1995.
[2]  M. S. Aapro, J. Bohlius, D. A. Cameron et al., “2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours,” European Journal of Cancer, vol. 47, no. 1, pp. 8–32, 2011.
[3]  A. D'Souza, I. Jaiyesimi, L. Trainor, and P. Venuturumili, “Granulocyte colony-stimulating factor administration: adverse events,” Transfusion Medicine Reviews, vol. 22, no. 4, pp. 280–290, 2008.
[4]  G. Morstyn, L. Campbell, L. M. Souza et al., “Effect of granulocyte colony stimulating factor on neutropenia induced by cytotoxic chemotherapy,” The Lancet, vol. 1, no. 8587, pp. 667–672, 1988.
[5]  H. J. Ross, L. A. Moy, R. Kaplan, and R. A. Figlin, “Bullous pyoderma gangrenosum after granulocyte colony-stimulating factor treatment,” Cancer, vol. 68, pp. 441–443, 1991.
[6]  J. M. L. White, G. J. Mufti, J. R. Salisbury, and A. W. P. Du Vivier, “Cutaneous manifestations of granulocyte colony-stimulating factor,” Clinical and Experimental Dermatology, vol. 31, no. 2, pp. 206–207, 2006.
[7]  K. K. Jain, “Cutaneous vasculitis associated with granulocyte colony-stimulating factor,” Journal of the American Academy of Dermatology, vol. 31, no. 2, pp. 213–215, 1994.
[8]  D. C. Dale, T. E. Cottle, C. J. Fier et al., “Severe chronic neutropenia: treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry,” American Journal of Hematology, vol. 72, no. 2, pp. 82–93, 2003.
[9]  T. Shiohara, Y. Sagawa, and M. Nagashima, “Systemic release of interferon-γ in drug-induced cutaneous vasculitis,” The Lancet, vol. 339, no. 8798, p. 933, 1992.
[10]  J. Elsner, J. Roesler, A. Emmendorffer, C. Zeidler, M.-L. Lohmann-Matthes, and K. Welte, “Altered function and surface marker expression of neutrophils induced by rhG-CSF treatment in severe congenital neutropenia,” European Journal of Haematology, vol. 48, no. 1, pp. 10–19, 1992.
[11]  H. Zoellner, E. L. Filonzi, H. R. Stanton, J. E. Layton, and J. A. Hamilton, “Human arterial smooth muscle cells synthesize granulocyte colony-stimulating factor in response to interleukin-1α and tumor necrosis factor- α,” Blood, vol. 80, no. 11, pp. 2805–2810, 1992.
[12]  K. Spiekermann, A. Emmendoerffer, J. Elsner et al., “Altered surface marker expression and function of G-CSF-induced neutrophils from test subjects and patients under chemotherapy,” British Journal of Haematology, vol. 87, no. 1, pp. 31–38, 1994.
[13]  T. E. Cottle, C. J. Fier, J. Donadieu, and S. E. Kinsey, “Risk and benefit of treatment of severe chronic neutropenia with granulocyte colony-stimulating factor,” Seminars in Hematology, vol. 39, no. 2, pp. 134–140, 2002.
[14]  S. Schmaldienst, G. Bekesi, R. Deicher, M. Franz, W. H. H?rl, and E. Pohanka, “Recombinant human granulocyte colony-stimulating factor after kidney transplantation: a retrospective analysis to evaluate the benefit or risk of immunostimulation,” Transplantation, vol. 69, no. 4, pp. 527–531, 2000.
[15]  C. Minguez, A. Mazuecos, M. Ceballos, F. Tejuca, and M. Rivero, “Worsening of renal function in a renal transplant patient treated with granulocyte colony-stimulating factor,” Nephrology Dialysis Transplantation, vol. 10, no. 11, pp. 2166–2167, 1995.
[16]  V. R. Peddi, S. Hariharan, T. J. Schroeder, and M. R. First, “Role of granulocyte colony stimulating factor (G-CSF) in reversing neutropenia in renal allograft recipients,” Clinical Transplantation, vol. 10, no. 1 I, pp. 20–23, 1996.
[17]  F. P. Hurst, P. Belur, R. Nee et al., “Poor outcomes associated with neutropenia after kidney transplantation: analysis of united states renal data system,” Transplantation, vol. 92, no. 1, pp. 36–40, 2011.

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