Granulocyte colony stimulating factor-associated aortitis evaluated via multiple imaging modalities including vascular echography: a case report

Abstract

Background Granulocyte colony stimulating factor (G-CSF) preparations are used for patients with granulocytopenia, especially to prevent febrile neutropenia. Arteritis has been recognized as a side effect of G-CSF treatment; however, there are no clear diagnostic criteria or treatment guidelines because not enough cases have been reported. Present case showed one of the diagnostic and treatment selection methods via multiple imaging modality including vascular echography. Case summary A 52-year-old woman underwent chemotherapy for ovarian cancer and received G-CSF because of myelosuppression. The patient experienced high and remittent fever that persisted during treatment using antibiotics and acetaminophen. Enhanced computed tomography revealed thickening of the tissue around the aortic arch and abdominal aorta. Echography of the abdominal aorta revealed thickening of the wall and a hypoechoic region around the aorta. Gadolinium-enhanced magnetic resonance imaging and 18F-fludeoxyglucose positron emission tomography also revealed that the inflammation was localized to the lesion. A suspicion of G-CSF-associated aortitis was based on the patient’s history and the exclusion of other diseases that might have caused the aortitis. Her condition rapidly improved after starting corticosteroid treatment. Discussion The differential diagnosis in similar cases should consider immune diseases that cause large-vessel arteritis (Takayasu arteritis, giant cell arteritis, and another vasculitis), infection, drug-induced disease, and immunoglobulin G4-related disease. The use of different imaging modalities, including vascular echography, helped guide the diagnosis and follow-up. It is necessary to evaluate the patient’s general condition before the selection of treatments.

Granulocyte colony-stimulating factor-associated aortitis in a woman with breast cancer: a case report

“…Although there are reports of G-CSF re-administration after symptom improvement in patients with G-CSFassociated aortitis, caution is required because some patients had recurrent aortitis [6,14]. In this case, at the patient's request, we shifted to endocrine therapy without re-administering PEG-G, and aortitis recurrence was not observed for 15 months after the onset of symptoms.…”

“…Moreover, previous reports show that there is no difference in the therapeutic effect and the time to remission of G-CSF-associated aortitis with or without corticosteroids [7]. The cases of G-CSF-associated aortitis reported in recent years are listed in Table 3 [6][7][8][9][10][11][12][13]. Aortitis caused by PEG-G tended to develop within 2 weeks of G-CSF administration and to resolve spontaneously within 3 weeks, as in the present case.…”

“…However, there is no established treatment for G-CSF-associated aortitis. In general, G-CSFassociated aortitis has good prognosis and often resolves spontaneously without the administration of corticosteroids [6]. Moreover, previous reports show that there is no difference in the therapeutic effect and the time to remission of G-CSF-associated aortitis with or without corticosteroids [7].…”

Granulocyte-Colony Stimulating Factor (G-CSF)-Induced Aortitis: A Case Report

“…Steroids are known for their potent anti-inflammatory effects and can be effective in reducing inflammation of the aorta. The use of steroids might be considered in more severe cases or when symptoms persist despite the discontinuation of G-CSF [ 5 , 11 , 12 ]. There are reports that the time from onset to remission was not significantly different between patients who used steroids and those who did not, so it is not clear whether steroids should be used or not [ 7 ].…”

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.…”