Large vessel vasculitis secondary to granulocyte-colony stimulating factor

Castillo, Jonathan; Loarce-Martos, Jesús; Blanc-Molina, José Miguel

doi:10.1024/0301-1526/a000872

Cited by 7 publications

(2 citation statements)

References 18 publications

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“…In one case of large-vessel vasculitis after pegfilgrastim administration, the patient was transitioned to nonpegylated G-CSF with additional cycles of chemotherapy administered without relapse of vasculitis [ 16 ]. Still, other case reports indicate that both pegylated and nonpegylated G-CSF can be associated with the development of aortitis [ 10 ]. One case report suggested that those who received pegylated G-CSF required steroids and those who received nonpegylated G-CSF had resolution of vasculitis without steroids [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Large-Vessel Vasculitis following Checkpoint Inhibitor Therapy and Pegfilgrastim

Mort

Maheshwari

Basu

et al. 2022

Case Reports in Oncological Medicine

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Checkpoint inhibitors (CPIs) and pegfilgrastim, a long-acting growth factor agent, are vital components of current cancer treatments. Immune-related adverse events (irAEs) such as colitis and pneumonitis are well-established toxicities associated with CPI therapy. However, large-vessel vasculitis secondary to CPI utilization is reported only in rare case reports and case series. Interestingly, large-vessel vasculitis has also been reported as a rare complication of pegfilgrastim use. We present a 59-year-old female with left stage IIA (cT2N0M0) triple-negative breast cancer receiving neoadjuvant decitabine and pembrolizumab prior to neoadjuvant chemotherapy (NAC). NAC included standard-of-care dose dense doxorubicin and cyclophosphamide (ddAC) supported with pegfilgrastim use followed by weekly carboplatin and paclitaxel. After receiving her second cycle of ddAC with pegfilgrastim, the patient reported five days of left shoulder and arm pain. Subsequent CT imaging demonstrated wall thickening and inflammatory changes surrounding the left subclavian artery, aortic arch, left carotid artery, proximal innominate arteries, and the mid internal carotid arteries and its branching vessels. These findings were extremely concerning for large-vessel vasculitis. Excluding CPI therapy and pegfilgrastim use, no additional inciting event or medication that the patient was exposed to was noted to be associated with large-vessel vasculitis. We present this case to report on this rare but severe complication from commonly utilized agents in cancer treatment. We also extend the possibility of large-vessel vasculitis development in relation to the COVID-19 vaccine due to shared ingredients found in both the vaccine and pegfilgrastim. It is important to outline the treatment used for such a complication as no standardized treatment has been established for large-vessel vasculitis caused by CPI therapy or pegfilgrastim use.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of Large-Vessel Vasculitis following Checkpoint Inhibitor Therapy and Pegfilgrastim

Mort

Maheshwari

Basu

et al. 2022

Case Reports in Oncological Medicine

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“…Although some patients with G-CSF-vasculitis improved with discontinuation of G-CSF alone and without corticosteroid therapy [ 2 , 4 ], aortic dissection and aneurysm have been reported as rare complications, which can appear in an acute course within a few weeks after the onset of vasculitis [ 7 , 8 ]. The cases treated with corticosteroids reached fever resolution within a few days [ 9 - 15 ], while it took one to three weeks for those treated without corticosteroids to reach fever resolution [ 1 , 4 , 13 , 16 - 20 ]. Since G-CSF-induced vasculitis occurs mainly in patients with malignancy, persistent fever due to G-CSF-induced vasculitis leads to the postponement of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Granulocyte-Colony Stimulating Factor-Induced Vasculitis Successfully Treated With Short-Term Corticosteroid Therapy: A Case Report

Yamamoto¹,

Waki²,

Maeda³

2021

Cureus

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Granulocyte-colony stimulating factor (G-CSF) is widely used for preventing neutropenia, and large vessel vasculitis has been recognized as one of its severe adverse events. We report a case of diffuse large B-cell lymphoma in a 78-year-old woman in whom fever and right cervical pain developed after administration of filgrastim. Computed tomography and cervical artery ultrasound imaging revealed wall thickening in the right common carotid artery. We diagnosed her with G-CSF-induced vasculitis and administered prednisolone of 50 mg/day (1 mg/kg/day) to her. Her symptoms disappeared in a few days, and prednisolone was discontinued six weeks after initiation. G-CSF-induced vasculitis may be improved with short-term high-dose corticosteroids with rapid tapering.

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Aortitis and aortic dissection after administration of pegfilgrastim during adjuvant chemotherapy for early breast cancer

et al. 2022

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Large vessel vasculitis secondary to granulocyte-colony stimulating factor

Cited by 7 publications

References 18 publications

A Rare Case of Large-Vessel Vasculitis following Checkpoint Inhibitor Therapy and Pegfilgrastim

A Rare Case of Large-Vessel Vasculitis following Checkpoint Inhibitor Therapy and Pegfilgrastim

Granulocyte-Colony Stimulating Factor-Induced Vasculitis Successfully Treated With Short-Term Corticosteroid Therapy: A Case Report

Aortitis and aortic dissection after administration of pegfilgrastim during adjuvant chemotherapy for early breast cancer

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