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

Abstract

<h3>REPORT OF A CASE</h3> 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 (<b>Figure 1</b>, 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<i>Pseudomonas aeruginosa.</i>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