Bullous pyoderma gangrenosum after granulocyte colony-stimulating factor treatment

Article Abstract:

One of the more serious side effects of chemotherapy for cancer is the suppression of bone marrow. Since the bone marrow produces many of the cells involved in the body's defenses, the cancer patient is especially vulnerable to many infections during the period required for the bone marrow to recover. There is great enthusiasm, therefore, for the therapeutic use of growth factors for the stimulation of bone marrow regeneration, although clinical trials to show an actual benefit for the patient are not yet complete. The notion is that the stimulation of the bone marrow will reduce the period required for recovery and thus also reduce the period during which the patient is susceptible to infection. One of the factors used in this manner is granulocyte colony-stimulating factor, or G-CSF. However, although this natural substance stimulates the recovery of granulocytes, which are white blood cells with a critical role in the fighting of infection, G-CSF is not without adverse side effects of its own. The side effects include bone pain and pain in the joints. A recent case illustrates that skin disorders may also result from the therapeutic use of G-CSF. The patient, a 50-year-old woman, received G-CSF after chemotherapy for lung cancer produced a large drop in the number of white blood cells. At the time of original diagnosis, it had been noticed that the patient had eczema, an inflammatory condition of the skin. About 10 days after the initiation of treatment with G-CSF, the patient began to develop painful boils at the sites originally affected by eczema. These boils were not infected, but were found to contain an infiltrate of neutrophils, a type of granulocyte. The diagnosis was determined to be a condition called bullous pyoderma gangrenosum. These painful lesions of the skin disappeared when the administration of G-CSF was halted and topical cream was applied. This case indicates that G-CSF can exacerbate inflammatory lesions. The observations suggest that patients with preexisting inflammatory conditions should be monitored carefully if granulocyte colony-stimulating factor is used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Granulocyte colony-stimulating factor

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The protean manifestations of hemorrhagic fever with renal syndrome

Article Abstract:

Hemorrhagic fever with renal syndrome is an illness characterized by fever, kidney failure, hemorrhage, and thrombocytopenia or decreased numbers of platelets (cells involved in blood clotting). This disease is caused by the Hantavirus, which is carried by rodents and transmitted to humans by direct contact or inhalation of rodent excrement. Hantavirus infection can be diagnosed by the identification of antibodies or immune proteins, which specifically bind to Hantavirus. Hemorrhagic fever with renal syndrome occurs mainly in northern Asia, the Soviet Union, Scandinavia, and Europe, although rodents throughout the world can be infected with Hantavirus. The clinical presentation and complications associated with Hantavirus infection were assessed by reviewing 26 cases of hemorrhagic fever with renal syndrome, which were diagnosed in US military personnel stationed in Korea between 1981 and 1986. Hantavirus infection was diagnosed by identifying Hantavirus antibody in 25 cases and by autopsy in 1 case. The infection was classified into three forms, with fever present in all types. One form of the illness, occurring in two patients, was associated with symptoms of sepsis (bacterial infection of the blood), shock (inadequate peripheral blood flow), diffuse bleeding, and rapid progression to death as a result of failure of several organ systems. Another form of Hantavirus infection affected 18 patients and was characterized by edema or accumulation of fluid in the lungs, bleeding within the abdominal area, and minimally impaired kidney function. The last form affected six patients and was typified by normal kidney function, fever, thrombocytopenia, abnormal urine tests, and increased blood levels of the enzyme transaminase. Tests for Hantavirus antibody may be used to identify unsuspected cases of hemorrhagic fever with renal syndrome, determine the geographic distribution of Hantavirus infection, and increase knowledge about the symptoms of this illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Identification and classification, Kidney diseases, Hantavirus infections, Hantaviruses

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Tumor necrosis factor induces hemorrhagic necrosis of a sarcoma

Article Abstract:

When bacteria break down, they release a substance called endotoxin, which causes the release of tumor necrosis factor from macrophages, (blood cells with phagocytic properties, meaning that they have the ability to ingest particles). In 1974, tumor necrosis factor was shown to cause the deterioration of a mouse cell tumor. In 1984, human tumor necrosis factor was produced by recombinant technology, in which the human genetic material which codes for the factor is combined with the genetic material of an organism, most commonly bacteria, and this results in the production of large amounts of the tumor necrosis factor. A case is described in which the recombinant form of human tumor necrosis factor caused the deterioration of a sarcoma, a tumor of connective tissue in a 53-year-old man. The patient was diagnosed as having a fibrosarcoma located at the junction of the neck and right shoulder. The tumor developed in an area that had been irradiated 14 years earlier for treatment of a lymphoid cancer. The patient had taken several anticancer agents that caused hypotension, or an abnormal drop in blood pressure, and worsening of the disease. The patient was then enlisted in a clinical trial or experimental drug study testing the effectiveness of recombinant tumor necrosis factor. Although the tumor necrosis factor caused hypotension, it produced a rapid and hemorrhagic deterioration of the sarcoma. The rapid effects of tumor necrosis factor may be related to changes in the blood vessels of the tumor, whereas the factor's long-term effects may involve changes in the body's natural defense mechanisms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Tumor necrosis factor, Blood vessels, Sarcoma

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