Acute arteritis after G-CSF administration

Abstract

Granulocyte colony-stimulating factor (G-CSF) is commonly used in clinical practice to accelerate neutropenia recovery after chemotherapy. G-CSF is a myeloid growth factor produced by monocytes, macrophages, fibroblasts and endothelial cells. Generally, aortitis and arteritis are not a known side effect of G-CSF and is thought to be extremely rare. Here, we present a case of a 77-year-old woman who underwent adjuvant chemotherapy (combined paclitaxel and carboplatin) for ovarian cancer, and then developed acute arteritis after receiving G-CSF. She developed grade 4 neutropenia on day 7 of the third chemotherapy cycle and received six G-CSF administrations. Two days after G-CSF administration, she came down with a high-grade fever that persisted for 2 weeks. Laboratory tests revealed a white blood cell count of 8700 UI, neutrophilic sequestration of 61.5%, and C-reactive protein of 8.43 mg/dl at the highest point of her fever. Considering that we were initially treating neutropenia, we diagnosed a bacterial infection, and she was treated with a course of antibiotics. However, her blood and urinalysis cultures were negative, and antibiotics were ineffective; thus, we performed a computed tomography scan to search for the cause of her persistent fever. The computed tomography scan showed remarkable thickness of the bilateral common carotid artery and the left subclavian artery consistent with arteritis. With cessation of the antibiotics course, she was followed closely without therapy, and her condition resolved in a few days. We conclude that G-CSF induced arteritis due to our exclusion of other probable etiologies.

The incidence and clinical features of PEGylated filgrastim-induced acute aortitis in patients with breast cancer

“…Few case reports showed the aortitis caused by gemcitabine or bevacizumab 30 – 32 . Similary with the preivous data 8 , 11 – 13 , 17 – 19 , docetaxel was concorrently used in our aortitis patients. However, aortitis did not recur during the remainder of docetaxel chemotherapy without G-CSF after aortitis.…”

“…Based on this immune-related vascular inflammation as one of the main mechanisms underlying the development of aortitis, all our patients were treated with short-term steroids to induce immunosuppression. While some data showed spontaneous improvement of aortitis without anti-inflammatory agents 8 , 11 , we thought that the recovery without anti-inflammatory agents might take longer than for the use of glucocorticoid, and delay recovery could directly affect the anticancer treatment schedule. Anticipating no further delay in chemotherapy, it may be reasonable to consider short-term glucocorticoid treatment.…”

Granulocyte colony stimulating factor (G-CSF)-induced aortitis in a patient undergoing adjuvant chemotherapy for breast cancer

“…A review of 10 published case reports identified from PubMed are summarised in table 1 7–16. The existing case reports describe similar presenting features with patients developing an acute onset of symptoms mimicking an infective picture and most cases describing a rapid resolution of symptoms 7 8 11 12 14–16.…”

The role of granulocyte colony‑stimulating factor in breast cancer development: A review

“…Secreted G-cSF not only has an antiapoptotic effect but also promotes the formation of tumors by mobilizing MdScs to inhibit T cell activity and Bv8 secretion (12). in some clinical case reports, the use of safe therapeutic doses of G-cSF may cause unpredictable side effects such as bone pain, local skin reactions at the injection site and even spleen rupture or infarction (93)(94)(95)(96). This evidence also raised concerns for clinical work.…”