Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan 17;15(1):e247237.
doi: 10.1136/bcr-2021-247237.

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

Rehan Asif  1 , Gwenllian Edwards  2 , Annabel Borley  2 , Sharon Jones  3
Affiliations
Case Reports

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

Rehan Asif et al. BMJ Case Rep. .

Abstract

Granulocyte colony stimulating factor (G-CSF) is used to prevent febrile neutropenia post chemotherapy. Usually well tolerated with minimal side effects but aortitis is an extremely rare side effect previously reported. A 64-year-old woman treated with adjuvant chemotherapy including G-CSF for left breast cancer was admitted with fevers, neutropenia and markedly raised inflammatory markers after 7 days of her first cycle. Initially diagnosed with neutropenic sepsis, she did not respond to broad spectrum antibiotics with subsequent CT imaging revealing marked periaortic inflammatory changes consistent with aortitis and periaortitis. Extensive investigations for other causes of large vessel vasculitis were negative and G-CSF was the only causative factor. She rapidly responded to steroids with almost complete resolution of inflammatory changes on repeat imaging within 4 weeks and no recurrence on tapering of steroids. This diagnosis must be considered in patients presenting with fever and raised inflammatory markers post G-CSF treatment.

Keywords: breast cancer; malignant disease and immunosuppression; unwanted effects / adverse reactions; vasculitis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Axial CT slices demonstrating marked periaortic inflammatory changes of the lower thoracic aorta and aortic arch.
Figure 2
Figure 2
Complete resolution of periaortic inflammatory changes of the lower thoracic aorta and aortic arch post-treatment.
See this image and copyright information in PMC

References

    1. Lardieri A, McCulley L, Christopher Jones S, et al. . Granulocyte colony-stimulating factors and aortitis: a rare adverse event. Am J Hematol 2018;93:E333–6. 10.1002/ajh.25220 - DOI - PubMed
    1. Taimen K, Heino S, Kohonen I, et al. . Granulocyte colony-stimulating factor- and chemotherapy-induced large-vessel vasculitis: six patient cases and a systematic literature review. Rheumatol Adv Pract 2020;4:rkaa004. 10.1093/rap/rkaa004 - DOI - PMC - PubMed
    1. Muzzana M, Pedrazzoli P, Lasagna A. G-Csf and G-CSF-related vasculitis: a systematic review of the literature and intriguing future research perspectives. Future Oncol 2021;17:4619–34. 10.2217/fon-2021-0701 - DOI - PubMed
    1. Sato Y, Kaji S, Ueda H, et al. . Thoracic aortitis and aortic dissection following pegfilgrastim administration. Eur J Cardiothorac Surg 2017;52:993–4. 10.1093/ejcts/ezx165 - DOI - PubMed
    1. Oshima Y, Takahashi S, Tani K, et al. . Granulocyte colony-stimulating factor-associated aortitis in the Japanese adverse drug event report database. Cytokine 2019;119:47–51. 10.1016/j.cyto.2019.02.013 - DOI - PubMed

Publication types

MeSH terms

Substances