Aortitis is a rare disorder involving inflammation of one or more layers of the aortic wall and is a risk factor for acute aortic syndromes, including aortic dissection and rupture. 1 It presents with nonspecific symptoms such as abdominal pain, back pain, fever, malaise, and elevated inflammatory markers, which make diagnosis challenging. Aortitis can be classified as either infectious or noninfectious. Infectious causes are rarer than noninfectious, which include rheumatologic disorders such as giant cell arteritis and Takayasu arteritis. 1 We report a case series of fulminant aortitis associated with the use of granulocyte colony-stimulating factor (G-CSF), a myeloid growth factor indicated to reduce the duration of neutropenia and neutropenia-related clinical sequelae.We searched the FDA adverse event reporting system (FAERS) and the medical literature through April 5, 2018 for post-marketing cases of aortitis in patients treated with G-CSFs. In addition to filgrastim and pegfilgrastim, the biologic tbo-filgrastim and the biosimilar filgrastim-sndz were included in this search, as well as lipegfilgrastim and lenograstim, two chemically distinct G-CSFs that are only available outside of the US. Cases were included if there was a temporal exposure to a G-CSF and a diagnosis of aortitis was reported by a health care professional. Cases were excluded if the adverse event was not aortitis, aortitis was attributed to an alternate etiology, or insufficient information was provided.We identified 15 FAERS cases of G-CSF associated aortitis that met our case definition, four of which were also published in the literature. Nine cases were associated with the long acting pegfilgrastim, four with filgrastim, and one with lenograstim. Twelve cases occurred in women and the mean patient age was 62 years old. Table 1 In all cases, aortitis was unlikely attributed to underlying disease or other drugs. Two cases received G-CSF as a stem cell donor, one of which was an otherwise healthy 55-year old female who developed aortitis 6 days after her initial dose of filgrastim. 4 All patients with an underlying cancer diagnosis (n = 13) received chemotherapy concomitantly with the G-CSF product. Cases received a variety of chemotherapeutic agents, (bevacizumab, carboplatin, cisplatin, cyclophosphamide, docetaxel, doxorubicin, epirubicin, fluorouracil, paclitaxel, pertuzumab, rituximab, trastuzumab, and vincristine) none of which have been associated with aortitis. None of the cases had a history of aortic disease.
