Has exanthema (rash) been reported in association with Neupogen (filgrastim)?/nA 40-year-old man de

Fråga: Has exanthema (rash) been reported in association with Neupogen (filgrastim)? A 40-year-old man develops exanthema on his trunk, neck and back five days after starting treatment with filgrastim. The spots were confluent, non-itching and cleared on pressure. The patient recalls a similar reaction several years ago after using Nezeril (oxymethazoline). Other medications: Kalcitena (calcium carbonate) 2 g.

Sammanfattning: Filgrastim has been reported to cause exanthema. In the present case a causal relationship seams feasible.

Svar: Cutaneous reactions such as local reactions, folliculitis, vasculitis, exacerbation of psoriasis, neutrophilic dermatitis (Sweet syndrome), pyoderma gangrenosum, and generalised rash are known adverse drug reactions (ADR) of filgrastim (1).

In a literature search we found 3 studies and several case reports concerning specifically filgrastim and rash. In two-phase III studies (2,3), 336 patients with small-cell lung cancer receiving cyclosphamide, doxorubicin and etoposide were randomised to filgrastim (230 ug/m2/day) or to placebo. About 8 per cent of the patients were reported to have developed generalised rash. In another study (4), patients (n=123) with chronic neutropenia were treated with filgrastim 3.5 to 11.5 mg/kg/day for 5 months. During the five-month treatment period, around 30 per cent of the patients developed rash. In a recent report (5), Glass et al reported 3 cases of generalised cutaneous reactions after using filgrastim. The patients were all women at the ages of 52, 43 and 36 years with leukaemia, breast cancer and Hodgkins disease, respectively. Approximately 3-4 weeks after starting filgrastim (10-30 ug/kg/day), they developed erythematous papules and plaques on the extremities that became more generalised and morbiliform. The reaction cleared in all the 3 patients after discontinuation of the drug.

In SWEDIS (6), there is one case of exanthema concerning a 27-year-old man with congenital hydrocephalus, which was shunted to the abdomen. The patient was treated with metronidazole and cephalosporine due to bacterial infection of the abdomen. A month later he developed agranulocytosis and both drugs were discontinued. Instead he was put on filgrastim and clindamycin (doses unknown). After an unspecified time the patient developed generalised uncomplicated exanthema. Both drugs were suspected to have caused the reaction. The outcome is unknown. In FASS (7), rash is listed as a less common ADR of filgrastim.

Calcium carbonate is not known to cause rash.

We recommend this case be reported to SADRAC (Swedish Adverse Drug Reactions Advisory Committee).