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Pyoderma gangrenosum complicating pegylated granulocyte colony‐stimulating factor in Hodgkin lymphoma

Pegylated granulocyte colony-stimulating factor (GCSF) (Pegfilgrastim/Neulasta, Amgen, Thousand Oaks, CA, USA) is a covalent conjugate of recombinant human GCSF and monomethoxypolyethyene glycol. Its advantage over regular GCSF is its reduced renal clearance and consequent prolonged persistence in vivo, allowing it to be administered in a single subcutaneous injection, once per cycle of chemotherapy. Pegylated GCSF does not routinely result in marked neutrophilia because serum clearance is directly related to the number of neutrophils. It is being used increasingly in oncology as a simple and cost-effective means of maintaining adequate neutrophil levels during intensive combination chemotherapy. We report here the occurrence of pyoderma gangrenosum following pegylated GCSF in a patient being treated for advanced Hodgkin lymphoma, who had previously received regular GCSF without incident. A previously fit 21-year-old female presented with clinical stage IIIB nodular sclerosing Hodgkin lymphoma. She was treated with combination chemotherapy according to the Adriamycin, Bleomycin, Vinblastine and Doxorubicin (ABVD) protocol. She was admitted to hospital following cycles 1A and 1B of chemotherapy with constipation and a urinary tract