Aortitis after granulocyte-colony stimulating factor administration: A case report

Abstract

Granulocyte-colony stimulating factor (G-CSF) is commonly used to reduce neutropenia-related complications following chemotherapy. It is a glycoprotein that stimulates the production of granulocytes [white blood cells (WBCs) in the bone marrow. In the present study, the case of a 59-year-old man is presented who received chemotherapy (eribulin) for liver metastases from sacral chordoma and subsequently developed acute aortitis after the administration of G-CSF. Grade 3 neutropenia occurred on day eight of the fifth chemotherapy cycle, and pegfilgrastim was administered on day nine. A total of 3 days after pegfilgrastim administration, the patient developed a fever that persisted for 6 days. He visited our hospital on day 18 with abdominal pain and elevated WBC count and C-reactive protein levels. Febrile neutropenia was suspected, and antibiotics were administered. However, both blood and urinalysis cultures returned negative results, and antibiotics were ineffective. Contrast-enhanced computed tomography revealed a thickened wall of the brachiocephalic artery and abdominal aorta, consistent with aortitis. After discontinuing the antibiotics, the patient was monitored closely without further treatment. His condition improved within a few days; therefore, it was concluded that aortitis was induced by G-CSF.

Keywords: G-CSF; adverse event; aortitis; chemotherapy; chordoma.

Figure 1

Imaging findings on admission. Scale bars, 5 cm. (A) Chest X-ray revealed a blunt left costophrenic angle. (B) Thoracic computed tomography showed left pleural effusion with no signs of pneumonia. (C) No significant progression was observed at the primary site in the sacrum. (D) No significant progression was observed at the metastatic sites in the liver.

Figure 2

CT scan findings. Scale bars, 1 cm. (A) Non-contrast CT showed periaortic soft tissue inflammation around the brachiocephalic artery (left) and abdominal aorta (right). (B) Contrast-enhanced CT showed thickening of the walls of the brachiocephalic artery (left) and abdominal aorta (right). CT, computed tomography.

Figure 3

Computed tomography scan findings two months after granulocyte-colony stimulating factor discontinuation. Periaortic soft tissue inflammation around the brachiocephalic artery (left) and abdominal aorta (right) showed improvements. Scale bars, 1 cm.

Figure 4

Clinical course of G-CSF-induced aortitis. WBC and CRP levels and body temperature were elevated after G-CSF administration. These parameters improved after discontinuation of antibiotic treatment. G-CSF, granulocyte-colony stimulating factor; WBC, white blood cell; CRP, C-reactive protein.