G-CSF-induced aortitis: Two cases and review of the literature

Parodis, Ioannis; Dani, Lara; Notarnicola, A.; Martenhed, Git; Fernström, Pontus; Matikas, Alexios; Wiklander, Oscar P. B.

doi:10.1016/j.autrev.2018.12.011

Cited by 36 publications

(25 citation statements)

References 29 publications

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“…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.…”

Section: Discussionsupporting

confidence: 83%

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

Lee

Kim

et al. 2020

Sci Rep

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Although PEGylated filgrastim-induced aortitis is very rare and unknown clinically, some cases were reported and increasing, especially in breast cancer patients. The present study investigated the prevalence, clinical features and treatment of aortitis induced by PEGylated filgrastim in patients with breast cancer. A total of 2068 consecutive patients who underwent neoadjuvant/adjuvant chemotherapy with PEGylated filgrastim for breast cancer were enrolled. From the medical record, clinical, laboratory, medication, and imaging evaluation findings were collected. PEGylated filgrastim-induced aortitis was established in 0.3% of the study population. Common clinical presentations included extremely high fever and chest/back pain with high levels of inflammatory markers without any signs of infection. Contrast-enhanced computed tomography scans revealed typical enhancing wall thickening and periaortic soft tissue infiltration at various levels of aorta. All patients improved rapidly after treatment with modest doses of prednisolone (0.5 mg/kg/day) without any complications. Clinicians should be aware of aortitis as a possible complication of granulocyte-colony stimulating factor therapy, especially PEGylated filgrastim, given the frequent misdiagnoses in neutropenic patients undergoing chemotherapy.

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Section: Discussionsupporting

confidence: 83%

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

Lee

Kim

et al. 2020

Sci Rep

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“…To gather data related to G-CSF-induced aortitis, we searched the PubMed database using the term "G-CSF AND aortitis" (6). Seventeen case reports were found between 2004 and 2019 (5,(7)(8)(9)(10)(11). In addition to the previous reports, a total of 21 cases were summarized, including the present case and other cases from our department (Table).…”

Section: Discussionmentioning

confidence: 99%

“…However, it should also be noted that intense acute inflammation can rarely cause fatal side effects, such as asymptomatic aortic dissection, as previously reported ( 11 ). Parodis et al reviewed the contribution of corticosteroids and concluded that moderate-to-high doses of corticosteroids should be started immediately following the diagnosis ( 10 ). Since vascular inflammation can improve spontaneously, as shown in the present case, it is difficult to conclude that immunosuppressants should be initiated for the treatment of LVV.…”

Section: Discussionmentioning

confidence: 99%

Migratory Aortitis Associated with Granulocyte-colony-stimulating Factor

et al. 2020

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We herein report a case of migratory aortitis after the administration of granulocyte-colony-stimulating factor (G-CSF) to a 65-year-old woman with a history of pancreatic cancer. She was being administered pegfilgrastim and developed aortitis around the aortic arch. Although it resolved within two weeks, she again developed aortitis around the descending aorta, presenting as migratory aortitis, after pegfilgrastim was resumed. We further experienced three additional cases of G-CSF-induced aortitis that also showed spontaneous resolution, suggesting no or short-term use of immunosuppression. Aortitis due to G-CSF can present as migratory aortitis, since aortitis can quickly resolve and inflammation can recur at a different location.

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“…We also checked the references cited in the original articles, and finally identified 10 cases of G-CSF-associated aortitis including the present case (Table 1). The primary diseases included four breast cancer cases [10, 11], two lung cancer cases [12, 13], and one case of ovarian cancer [14]. G-CSF was used to prevent chemotherapy-induced FN in these cases.…”

Section: Discussionmentioning

confidence: 99%

Granulocyte-colony stimulating factor-associated aortitis in a woman with advanced breast cancer: a case report and review of the literature

Hoshina

Takei

2019

BMC Cancer

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BackgroundGranulocyte-colony stimulating factor (G-CSF) is increasingly been used to prevent febrile neutropenia (FN) associated with the administration of chemotherapy for various cancers. The most common adverse effects of G-CSF are bone pain and injection-site reactions and aortitis has rarely been reported. We report herein a rare case of G-CSF associated with aortitis in a woman with advanced breast cancer.Case presentationA 72-year-old woman with estrogen receptor-negative human epidermal growth factor 2-positive breast cancer with distant metastases in the lung was admitted. Her treatment was initiated with docetaxel in combination with trastuzumab and pertuzumab followed by the supportive use of a long-acting G-CSF, pegfilgrastim. After administration of pegfilgrastim on day 5, the patient had an intermittent fever (body temperature up to 39.6 °C) on day 9 which continued irrespective of taking levofloxacin. She visited our outpatient clinic on day 13 with no objective symptoms other than fever. Laboratory tests revealed a high neutrophil count (15,000/μl) and a high C-reactive protein (CRP) level (46.35 mg/dl) without any other abnormalities. There was no response upon administration of antimicrobial agents. An 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed thickening of the wall of the descending thoracic aorta and left pleural effusion. Therefore, thoracic aortitis induced by pegfilgrastim was suspected. On day 19, the fever resolved spontaneously followed by a gradual reduction in the neutrophil count and CRP level. In the follow-up CT, the aortic wall thickness and pleural effusion had disappeared.ConclusionsG-CSF may cause aortitis due to stimulation of the production of inflammatory cytokines. In case of high continuous fever after administration of pegfilgrastim, aortitis should be suspected unless there are other infectious findings.

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G-CSF-induced aortitis: Two cases and review of the literature

Cited by 36 publications

References 29 publications

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

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

Migratory Aortitis Associated with Granulocyte-colony-stimulating Factor

Granulocyte-colony stimulating factor-associated aortitis in a woman with advanced breast cancer: a case report and review of the literature

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