Rash associated with the use of pegylated filgrastim in a patient with advanced pancreatic cancer.

Filgrastim and pegfilgrastim are granulocyte colony-stimulating factor (G-CSF) products, which have been part of the supportive treatment of cancer patients for years to increase the white blood cell count and absolute neutrophil count with the primary objective of preventing the appearance of neutropenic fever in patients at risk because of the very toxic chemotherapy. Pegfilgrastim is a glycosylated form of filgrastim with a prolonged duration of effect, a reduced renal clearance, and relatively fewer side effects. Rash in particular has been described rarely (less than 3.7% of cases). Various dermatologic complications have been associated with G-CSF therapy, with filgastrim more than pegfilgrastim. These complications include local skin reactions, folliculitis, vasculitis, and pyoderma gangrenosum as well as the more classic generalized allergic rash associated both with and without anaphylaxis. We present a patient with pancreatic cancer who developed facial rash related to the use of pegfilgrastim that led to discontinuation of the agent and we review the literature on this topic.