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August 1995

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

Author Affiliations

Groupe Hospitalier Pitié-Salpêtrière, Paris, France

Arch Dermatol. 1995;131(8):892-894. doi:10.1001/archderm.1995.01690200026005

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

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