Epidermolysis bullosa acquisita induced by GM-CSF: a role for eosinophils in treatment-related toxicity
Jeffery C. Ward
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorJeffrey B. Gitlin
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorDaniel J. Garry
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorAminah Jatoi
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorSharon D. Luikart
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorBrian D. Zelickson
Department of Dermatology, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorMark V. Dahl
Department of Dermatology, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorCorresponding Author
Keith M. Skubitz
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Dr K. M. Skubitz, Box 325 University Hospital, Minneapolis, MN 55455, U.S.A.Search for more papers by this authorJeffery C. Ward
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorJeffrey B. Gitlin
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorDaniel J. Garry
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorAminah Jatoi
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorSharon D. Luikart
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorBrian D. Zelickson
Department of Dermatology, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorMark V. Dahl
Department of Dermatology, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Search for more papers by this authorCorresponding Author
Keith M. Skubitz
Department of Medicine, University of Minnesota Medical School, and Masonic Cancer Center, Minneapolis, Minnesota
Dr K. M. Skubitz, Box 325 University Hospital, Minneapolis, MN 55455, U.S.A.Search for more papers by this authorAbstract
A patient treated with granulocyte-macrophage colony-stimulating factor (GM-CSF) developed eosinophilia and epidermolysis bullosa acquisita. The bullae were subepi-dermal, and filled with an inflammatory infiltrate composed predominantly of eosinophils. Immunofluorescence studies disclosed linear deposition of IgG, IgA and C3 at the basement membrane zone and immunoelectron microscopy demonstrated antibody deposition in the lamina densa and sub-lamina densa region; however, the patient's serum did not contain circulating antibody to basement membrane zone antigens. Staining with monoclonal antibodies revealed dense deposits of both eosinophil peroxidase and eosinophil major basic protein at the dermal–epidermal junction. The eosinophilia and skin lesions resolved upon discontinuation of GM-CSF. This case provides evidence for two hypotheses: (1) GM-CSF induced proliferation and activation of eosinophils may contribute to some of the toxicities of GM-CSF treatment, and (2) activated granulocytes, including eosinophils, may mediate blister formation in epidermolysis bullosa acquisita.
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