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Sugai Y, Toyoguchi Y, Kanoto M, Kirii K, Hiraka T, Konno Y, Watarai F, Kamio Y, Seino M, Ohta T, Nagase S. Clinical and image features: large-vessel vasculitis after granulocyte colony stimulating factor administration. Acta Radiol 2024; 65:383-391. [PMID: 32536259 DOI: 10.1177/0284185120931685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Granulocyte colony stimulating factor (G-CSF) is known to cause vasculitis, mainly in the small vessels. Several cases of large-vessel vasculitis (LVV) caused by G-CSF have recently been reported in the literature; we retrospectively suspect that some cases of LVV in our institution were associated with administration of G-CSF. PURPOSE To evaluate the clinical and radiological findings in our cases and to compare them with those in previous reports. MATERIAL AND METHODS We retrospectively evaluated clinical and radiological findings in four cases of LVV that occurred after administration of G-CSF in our institution. We also reviewed papers on G-CSF-related LVV and compared their findings to ours. RESULTS G-CSF-related LVV occurred in patients aged > 50 years and more frequently in women. Most patients developed vasculitis within 15 days after the last administration. While 14/16 patients were symptomatic, the remaining two patients were asymptomatic and diagnosed incidentally. In all cases, laboratory inflammatory markers increased, but there were no autoantibodies that clearly indicated other autoimmune vasculitis. Computed tomography revealed elevated soft tissue density around the affected vessels. CONCLUSION LVV is among the potential adverse events of G-CSF administration. We should keep this outcome in mind when we interpret medical images of patients with previous G-CSF treatment history even if they are asymptomatic.
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Affiliation(s)
- Yasuhiro Sugai
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuuki Toyoguchi
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masafumi Kanoto
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kazukuni Kirii
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Toshitada Hiraka
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoshihiro Konno
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Fumika Watarai
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yukinori Kamio
- First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Manabu Seino
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tsuyoshi Ohta
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
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2
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Ito M, Amari M, Sato A, Hikichi M. Granulocyte-Colony Stimulating Factor (G-CSF)-Induced Aortitis: A Case Report. Cureus 2024; 16:e54845. [PMID: 38533155 PMCID: PMC10964047 DOI: 10.7759/cureus.54845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Pegylated granulocyte colony-stimulating factor (G-CSF), commonly used in chemotherapy-induced neutropenia, has been associated with rare instances of aortitis. This study describes a 67-year-old female patient with estrogen receptor (ER)-positive, human epidermal growth factor receptor-2-positive breast cancer, undergoing chemotherapy with an epirubicin/cyclophosphamide (EC) regimen (epirubicin, cyclophosphamide) and pegylated G-CSF for neutropenia prophylaxis. Post-treatment, she developed symptoms including intermittent fever and severe arthralgia. Laboratory tests revealed an elevated white blood cell count, C-reactive protein levels, and erythrocyte sedimentation rate, while a computed tomography scan showed thickening in the aortic arch and descending aorta. Given the clinical presentation and exclusion of other potential causes, pegylated G-CSF-induced aortitis was suspected. The patient's symptoms improved significantly following the cessation of pegylated G-CSF, aiding in the differentiation from other types of aortitis. This study highlights the importance of considering pegylated G-CSF as a potential cause of aortitis in patients presenting with unexplained symptoms of fever and inflammation after chemotherapy. The rapid improvement upon discontinuation of the drug is a key feature distinguishing it from other aortitis causes. In conclusion, while rare, aortitis should be considered in the differential diagnosis of patients treated with pegylated G-CSF who exhibit relevant clinical symptoms. Early detection and management, including the discontinuation of the causative agent, are crucial for patient recovery and prognosis.
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Affiliation(s)
- Masahiro Ito
- Breast Surgery, Tohoku Kosai Hospital, Sendai, JPN
| | | | - Akiko Sato
- Breast Surgery, Tohoku Kosai Hospital, Sendai, JPN
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3
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Iida K, Honda Y, Homma Y. Granulocyte colony-stimulating factor-induced aortitis with temporal arteritis and monoarthritis. BMJ Case Rep 2023; 16:e251216. [PMID: 36750306 PMCID: PMC9906274 DOI: 10.1136/bcr-2022-251216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
We present the case of a patient in his 80s receiving gemcitabine-cisplatin therapy for bladder cancer who developed neutropenia and was treated with filgrastim. In 10 days, the patient developed a mild fever with left jaw claudication and right knee arthritis. Contrast-enhanced CT findings indicated aortitis. Prednisolone was started for granulocyte colony-stimulating factor (G-CSF)-induced aortitis, and symptoms and elevated serum inflammatory markers resolved rapidly, allowing early discontinuation of prednisolone. Right knee arthritis relapsed at the initial follow-up. Contrast-enhanced CT revealed aortitis had disappeared. Therefore, recurrence of G-CSF-induced arthritis was suspected; prednisolone was resumed for 29 days without relapse. Most previous reports of G-CSF-induced aortitis have described inflammation of the aorta, carotid arteries and subclavian arteries; however, G-CSF-induced aortitis may present with more peripheral symptoms, such as temporal arteritis and knee arthritis. Furthermore, G-CSF-induced aortitis reportedly responds well and rapidly to prednisolone, although early discontinuation may lead to relapse.
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Affiliation(s)
- Keisuke Iida
- General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuki Honda
- General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoichiro Homma
- General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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4
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Aymonnier K, Amsler J, Lamprecht P, Salama A, Witko‐Sarsat V. The neutrophil: A key resourceful agent in immune‐mediated vasculitis. Immunol Rev 2022; 314:326-356. [PMID: 36408947 DOI: 10.1111/imr.13170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The term "vasculitis" refers to a group of rare immune-mediated diseases characterized by the dysregulated immune system attacking blood vessels located in any organ of the body, including the skin, lungs, and kidneys. Vasculitides are classified according to the size of the vessel that is affected. Although this observation is not specific to small-, medium-, or large-vessel vasculitides, patients show a high circulating neutrophil-to-lymphocyte ratio, suggesting the direct or indirect involvement of neutrophils in these diseases. As first responders to infection or inflammation, neutrophils release cytotoxic mediators, including reactive oxygen species, proteases, and neutrophil extracellular traps. If not controlled, this dangerous arsenal can injure the vascular system, which acts as the main transport route for neutrophils, thereby amplifying the initial inflammatory stimulus and the recruitment of immune cells. This review highlights the ability of neutrophils to "set the tone" for immune cells and other cells in the vessel wall. Considering both their long-established and newly described roles, we extend their functions far beyond their direct host-damaging potential. We also review the roles of neutrophils in various types of primary vasculitis, including immune complex vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu arteritis, and Behçet's disease.
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Affiliation(s)
- Karen Aymonnier
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Jennifer Amsler
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology University of Lübeck Lübeck Germany
| | - Alan Salama
- Department of Renal Medicine, Royal Free Hospital University College London London UK
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5
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Seto Y, Kittaka N, Taniguchi A, Kanaoka H, Nakajima S, Oyama Y, Kusama H, Watanabe N, Matsui S, Nishio M, Fujisawa F, Takano K, Arita H, Nakayama T. Pegfilgrastim-induced vasculitis of the subclavian and basilar artery complicated by subarachnoid hemorrhage in a breast cancer patient: a case report and review of the literature. Surg Case Rep 2022; 8:155. [PMID: 35960391 PMCID: PMC9374851 DOI: 10.1186/s40792-022-01499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pegfilgrastim (PEG) is a sustained-duration pegylated form of filgrastim, a granulocyte-colony stimulating factor agent that is widely used as prophylaxis against febrile neutropenia during chemotherapy. We report the case of a breast cancer patient who developed PEG-induced vasculitis complicated by subarachnoid hemorrhage (SAH) and review the relevant literature.
Case presentation
A 48-year-old woman had undergone surgery for breast cancer and was receiving docetaxel and cyclophosphamide as adjuvant chemotherapy (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2); on day 4 of treatment, PEG had been administered. On day 14, she was admitted to hospital with fever, general malaise, and neck pain, and her C-reactive protein level was found to be high (12.65 mg/dL). Although infection was initially suspected, antimicrobial treatment was ineffective and other laboratory test results were negative for this. Contrast-enhanced computed tomography on day 22 showed thickened vessel walls in the left subclavian artery, the origin of the common carotid artery, and the thoracoabdominal aorta. On day 26, magnetic resonance imaging of the head to investigate possible causes of headache showed signs consistent with SAH, and magnetic resonance angiography images showed irregularity in the basilar artery wall; the findings of both studies were considered to be due to PEG-induced vasculitis. Once treatment with prednisolone 40 mg/day had started, the wall thickening and irregularity improved.
Conclusion
Although an uncommon adverse effect, vasculitis affecting vessels of various sizes may be caused by PEG. To the best of our knowledge, this report is the first to describe a case of G-CSF-induced vasculitis complicated by SAH. In cases of persistent high fever and elevated inflammatory response after PEG administration and in the absence of infection, clinicians should consider the possibility of drug-induced vasculitis.
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A Rare Case of Large-Vessel Vasculitis following Checkpoint Inhibitor Therapy and Pegfilgrastim. Case Rep Oncol Med 2022; 2022:7295305. [PMID: 35251725 PMCID: PMC8890883 DOI: 10.1155/2022/7295305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
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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Shiraki E, Hamada-Nishimoto M, Kang Y, Tsuyuki S. Aortitis and aortic dissection after administration of pegfilgrastim during adjuvant chemotherapy for early breast cancer. Int Cancer Conf J 2022; 11:138-141. [PMID: 35402137 PMCID: PMC8938564 DOI: 10.1007/s13691-022-00540-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
A 70 year-old woman on adjuvant chemotherapy for breast cancer developed acute aortitis after receiving pegfilgrastim. 12 days after pegfilgrastim administration, she presented to our hospital with fever and shoulder pain. White blood cell count and C-reactive protein were elevated. As the computed tomography scan revealed thickening of the walls of the aortic arch and surrounding arteries, we suspected granulocyte colony-stimulating factor-related aortitis. Although steroid treatment administered once improved the general condition, her symptoms and C-reactive protein worsened again. On increasing the steroid dose, her general condition recovered rapidly. On day 85, Stanford type A aortic dissection was incidentally detected by a follow-up computed tomography scan. Physicians should recognize these adverse events of filgrastim.
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Affiliation(s)
- Eriko Shiraki
- Department of Breast Surgery, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 Japan
| | - Mai Hamada-Nishimoto
- Department of Breast Surgery, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 Japan
| | - Yookija Kang
- Department of Breast Surgery, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 Japan
| | - Shigeru Tsuyuki
- Department of Breast Surgery, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555 Japan
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8
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Ramon A, Greigert H, Ornetti P, Bonnotte B, Samson M. Mimickers of Large Vessel Giant Cell Arteritis. J Clin Med 2022; 11:jcm11030495. [PMID: 35159949 PMCID: PMC8837104 DOI: 10.3390/jcm11030495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023] Open
Abstract
Giant cell arteritis (GCA) is a large-vessel granulomatous vasculitis occurring in patients over 50-year-old. Diagnosis can be challenging because there is no specific biological test or other diagnoses to consider. Two main phenotypes of GCA are distinguished and can be associated. First, cranial GCA, whose diagnosis is usually confirmed by the evidence of a non-necrotizing granulomatous panarteritis on temporal artery biopsy. Second, large-vessel GCA, whose related symptoms are less specific (fever, asthenia, and weight loss) and for which other diagnoses must be implemented if there is neither cephalic GCA nor associated polymyalgia rheumatica (PMR) features chronic infection (tuberculosis, Coxiella burnetti), IgG4-related disease, Erdheim Chester disease, and other primary vasculitis (Behçet disease, relapsing polychondritis, or VEXAS syndrome). Herein, we propose a review of the main differential diagnoses to be considered regarding large vessel vasculitis.
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Affiliation(s)
- André Ramon
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Correspondence:
| | - Hélène Greigert
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- Vascular Medicine Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Paul Ornetti
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport, 21000 Dijon, France
| | - Bernard Bonnotte
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Maxime Samson
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
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9
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Asif R, Edwards G, Borley A, Jones S. Granulocyte colony stimulating factor (G-CSF)-induced aortitis in a patient undergoing adjuvant chemotherapy for breast cancer. BMJ Case Rep 2022; 15:e247237. [PMID: 35039373 PMCID: PMC8768863 DOI: 10.1136/bcr-2021-247237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/03/2022] Open
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.
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Affiliation(s)
- Rehan Asif
- Rheumatology, University Hospital of Wales, Cardiff, UK
| | | | | | - Sharon Jones
- Rheumatology, University Hospital of Wales, Cardiff, UK
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10
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Nitta S, Tanaka T, Yanagihashi R, Nonaka H, Suzuki S, Kimura T, Kandori S, Hoshi A, Negoro H, Nishiyama H. Granulocyte colony-stimulating factor associated arteritis in a patient with castration-resistant prostate cancer. IJU Case Rep 2022; 5:29-31. [PMID: 35005466 PMCID: PMC8720713 DOI: 10.1002/iju5.12376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Granulocyte colony-stimulating factor-associated arteritis is a rare adverse event of granulocyte colony-stimulating factor, with an incidence of 0.47% among all patients who receive granulocyte colony-stimulating factor. We herein present a case of granulocyte colony-stimulating factor-associated arteritis. CASE PRESENTATION A 72-year-old man with castration-resistant prostate cancer and multiple bone metastases was treated with docetaxel and pegfilgrastim. He developed a high fever on day 12 without other symptoms. His white blood cell count and C-reactive protein levels were high. Antibiotic therapy was ineffective, and contrast-enhanced computed tomography showed thickened subclavian and brachiocephalic artery walls. He was diagnosed with granulocyte colony-stimulating factor-associated arteritis. CONCLUSION When patients receiving chemotherapy with granulocyte colony-stimulating factor develop an unexplained fever, granulocyte colony-stimulating factor associated arteritis should be considered.
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Affiliation(s)
- Satoshi Nitta
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Takazo Tanaka
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Ryota Yanagihashi
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Haruna Nonaka
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Shuhei Suzuki
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Tomokazu Kimura
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Shuya Kandori
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Akio Hoshi
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Hiromitsu Negoro
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Hiroyuki Nishiyama
- Department of UrologyFaculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
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11
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Hoshina H, Takei H. Granulocyte-colony stimulating factor-associated aortitis in cancer: A systematic literature review. Cancer Treat Res Commun 2021; 29:100454. [PMID: 34530312 DOI: 10.1016/j.ctarc.2021.100454] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/19/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aortitis following granulocyte-colony stimulating factor (G-CSF) administration has been reported in 0.3-0.47% of cases. To evaluate the characteristics of G-CSF-associated aortitis, we systematically reviewed the literature. METHODS We searched PubMed and found 49 cases of G-CSF-associated aortitis and cancer comorbidities and analyzed their characteristics and treatments. RESULTS Since 2004, cases of G-CSF-associated aortitis have been increasing, particularly in Asia (75.5%). The mean age was 60.1 years; 79.6% of patients were 50 years and older; and most patients were females (91.8%). All patients underwent chemotherapy (taxane, 51.0%). The most frequent symptom was fever, which occurred within 10 days (61.2%) of G-CSF administration, similar to that in febrile neutropenia. The period to remission was within 14 days in 44.9% of cases. Steroids were administered to 59.2% of patients; however, treatment efficacy was not significant. No patients died. CONCLUSIONS High levels of inflammatory cytokines might induce aortitis; however, further studies are warranted.
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Affiliation(s)
- Hideko Hoshina
- Department of Breast Surgery, Kikuna Memorial Hospital, 4-4-27 Kikuna, Kouhoku, Yokohama 222-0011, Kanagawa, Japan; Department of Breast Surgery and Oncology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8603, Japan.
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 113-8603, Japan
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12
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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; 17:4619-4634. [PMID: 34431371 DOI: 10.2217/fon-2021-0701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: There are several case reports suggesting that G-CSFs may, in rare conditions, produce serious side effects, such as vasculitis. Materials & methods: A systematic search was conducted in Medline via PubMed, Embase and Cochrane Library to describe this unusual side effect to raise awareness among clinicians for early recognition and treatment. Results: Fifty-seven patients were analyzed. The most prevalent cancer type was breast cancer (47%). Long-acting G-CSF was used in 38 patients (67%). Only 47% of patients were treated with steroids. Conclusion: Although the benefit of G-CSF treatment outweighs the potential damage, oncologists should consider the possibility of triggering a vascular toxicity and try to identify patients at increased risk for this side effect.
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Affiliation(s)
- Marta Muzzana
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, Pavia, Italy.,Department of Internal Medicine & Medical Therapy, University of Pavia, Viale Camillo Golgi 19, Pavia, Italy
| | - Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, Pavia, Italy
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13
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Kametani T, Otani Y, Ohigashi T, Kubo T, Sakuda T, Furuta D, Ito Y, Shigenobu Y, Kakimoto M, Kawahara A, Kikuchi Y, Kobayashi T, Miyamori D, Kishikawa N, Kanno K, Ito M. Granulocyte Colony-stimulating Factor-induced Aortitis with Lung Injury, Splenomegaly, and a Rash During Treatment for Recurrent Extraosseous Mucinous Chondrosarcoma. Intern Med 2021; 60:1311-1315. [PMID: 33191326 PMCID: PMC8112981 DOI: 10.2169/internalmedicine.5913-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of aortitis induced by granulocyte colony-stimulating factor (G-CSF) that coincided with lung injury, splenomegaly, and cutaneous manifestations during treatment for recurrent extraosseous mucinous chondrosarcoma. Computed tomography revealed large-vessel vasculitis, splenomegaly, and pulmonary interstitial changes. Treatment with prednisolone was successful. Because sarcoma is a rare disease, this case is valuable for showing clinicians that G-CSF preparations could cause aortitis regardless of the patient's underlying diseases or therapeutic pharmacological backgrounds.
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Affiliation(s)
- Takahiro Kametani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuichiro Otani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Toshikazu Ohigashi
- Department of Pharmaceutical Services, Hiroshima University Hospital, Japan
| | - Tadahiko Kubo
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Japan
| | - Tomohiko Sakuda
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Japan
| | - Daisuke Furuta
- Department of Orthopaedic Surgery, Hiroshima University, Graduate School of Biomedical & Health Sciences, Japan
| | - Yayoiko Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuya Shigenobu
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masaki Kakimoto
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Akihiro Kawahara
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuka Kikuchi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Tomoki Kobayashi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Nobusuke Kishikawa
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Keishi Kanno
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
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14
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Cheng C, Nguyen MN, Nayernama A, Jones SC, Brave M, Agrawal S, Amiri-Kordestani L, Woronow D. Arterial aneurysm and dissection with systemic vascular endothelial growth factor inhibitors: A review of cases reported to the FDA Adverse Event Reporting System and published in the literature. Vasc Med 2021; 26:526-534. [PMID: 33840328 DOI: 10.1177/1358863x211006470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The US Food and Drug Administration (FDA) has approved multiple systemic vascular endothelial growth factor (VEGF) inhibitors since 2004 to treat various malignancies. Inhibition of the VEGF signaling pathway can result in impairment of vascular wall integrity through medial degeneration and endothelial dysfunction, potentially resulting in arterial (including aortic) aneurysm/dissection. We performed a postmarketing review to evaluate arterial aneurysm/dissection as a potential safety risk for patients with cancer treated with VEGF inhibitors. We searched the FDA Adverse Event Reporting System (FAERS) database and literature for reports of arterial (including aortic) aneurysm/dissection with VEGF inhibitors currently approved by the FDA for a cancer indication. We identified 240 cases of arterial aneurysm/dissection associated with VEGF inhibitors. The median time to onset of an arterial aneurysm/dissection event from the initiation of a VEGF inhibitor was 94 days (range 1-1955 days). Notably, 22% (53/240) of cases reported fatal outcomes related to arterial aneurysm/dissection. We determined the drug-event association as probable in 15 cases that lacked relevant confounding factors for arterial aneurysm/dissection, which is supported by unremarkable computed tomography (CT) findings prior to starting VEGF inhibitor therapy, despite nondrug-associated background arterial aneurysm/dissection generally demonstrating preexisting arterial abnormalities. FAERS and literature case-level evidence suggests that VEGF inhibitors may have contributed to arterial aneurysm/dissection, as a class effect, based on short onset relative to natural history of disease and biologic plausibility. Cardiovascular and oncology healthcare professionals should be aware of this rare, but life-threatening safety risk associated with VEGF inhibitors.
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Affiliation(s)
- Connie Cheng
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michelle Nadeau Nguyen
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Afrouz Nayernama
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - S Christopher Jones
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Brave
- Division of Oncology, Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Sundeep Agrawal
- Division of Oncology, Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Laleh Amiri-Kordestani
- Division of Oncology, Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Daniel Woronow
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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15
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The incidence and clinical features of PEGylated filgrastim-induced acute aortitis in patients with breast cancer. Sci Rep 2020; 10:18647. [PMID: 33122662 PMCID: PMC7596224 DOI: 10.1038/s41598-020-75620-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/16/2020] [Indexed: 01/13/2023] Open
Abstract
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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16
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Mukai T, Kubo S, Morita Y, Yamamoto M, Ikeda M. Aortitis which developed after the administration of granulocyte-colony stimulating factor. Mod Rheumatol Case Rep 2020; 4:74-78. [PMID: 33086976 DOI: 10.1080/24725625.2019.1629570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Drug-induced aortitis is rare; thus, the diagnosis of drug-induced aortitis could be delayed unless clinicians are aware of the disease entity. Herein, we describe the case of a 66-year-old woman who developed aortitis after administration of granulocyte-colony stimulating factor (G-CSF) during chemotherapy for her breast cancer. Thickening of the aortic wall was clearly detected by computed tomography (CT) and magnetic resonance imaging. After excluding the other possible aetiologies, an association between G-CSF and the development of aortitis was highly suspected. Corticosteroid treatment rapidly regressed the aortitis, as confirmed by follow-up CT examination. G-CSF analog is generally well tolerated; however, there are limited case reports of G-CSF-associated aortitis, suggesting the causative effect of G-CSF in the development of aortitis. Currently, G-CSF-associated aortitis has received little attention among rheumatologists. As the delayed diagnosis results in irreversible changes in the aorta, not only oncologists but also rheumatologists should be aware of this unrecognized disease entity, G-CSF-associated aortitis.
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Affiliation(s)
- Tomoyuki Mukai
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan.,Department of Internal Medicine (Rheumatology), Fukuyama City Hospital, Fukuyama, Japan
| | - Shinichiro Kubo
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Yoshitaka Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Mari Yamamoto
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Masahiko Ikeda
- Department of Breast and Thyroid Surgery, Fukuyama City Hospital, Fukuyama, Japan
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17
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Mettler C, Chouchana L, Terrier B. Antineoplastic Drug-induced Aortitis: An Unraveled Adverse Effect Using the World Health Organization Pharmacovigilance Database. J Rheumatol 2020; 47:1298-1300. [PMID: 32482651 DOI: 10.3899/jrheum.200023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Camille Mettler
- Département de Médecine Interne, Centre de Référence National pour les maladies autoimmunes systémiques rares, Hôpital Cochin, AP-HP
| | - Laurent Chouchana
- Département de Pharmacologie, Centre Régional de Pharmacovigilance, Hôpital Cochin, AP-HP
| | - Benjamin Terrier
- Département de Médecine Interne, Centre de Référence National pour les maladies autoimmunes systémiques rares, Hôpital Cochin, AP-HP, and Université Paris Descartes, Paris, France.
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18
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Corral de la Fuente E, Barquín Garcia A, Saavedra Serrano C, Serrano Domingo JJ, Martín Huertas R, Fernández Abad M, Martínez Jáñez N. Myocarditis and carotidynia caused by Granulocyte-Colony stimulating factor administration. Mod Rheumatol Case Rep 2020; 4:318-323. [PMID: 33087005 DOI: 10.1080/24725625.2020.1754552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
A 59 year-old woman was treated with adjuvant chemotherapy for triple negative breast cancer (TNBC) stage IB. She received pegfilgrastrim as secondary prophylaxis of neutropenia. After administration of pegfilgrastrim on day 11, she was hospitalised because of carotidynia and myocarditis that improved with antibiotics and steroids as an infection was suspected. Once she was recovered, another cycle of chemotherapy with pegfilgrastrim was administrated. At this time, the patient presented to our hospital with fever, odynophagia and chest pain, with diagnosis of myocarditis coupled with cardiogenic shock. She received antibiotics and steroids, advanced life support and also a pericardial window was done, with recovery of her condition. After a complete evaluation and exclusion of other possible aetiologies, we concluded that pegfilgrastrim was responsible for inducing carotidynia and myocarditis. Few cases have been published about Granulocyte-Colony stimulating factor (G-CSF) induced carotidynia and aortitis. However, this is the first reported case about G-CSF induced myocarditis and carotidynia.
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Affiliation(s)
| | | | | | | | | | - María Fernández Abad
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
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19
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Abstract
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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Affiliation(s)
- Tsuyoshi Shirai
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
| | - Hiroka Komatsu
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
| | - Hiroko Sato
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Fujii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Japan
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20
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Soto Castillo JJ, Loarce-Martos J, Blanc-Molina JM. Large vessel vasculitis secondary to granulocyte-colony stimulating factor. VASA 2020; 49:509-513. [PMID: 32452726 DOI: 10.1024/0301-1526/a000872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aortitis is a rare entity that may cause fever of unknown origin. This entity has a wide various etiologies, which main cause is rheumatologic, but not only. Iatrogenia has also been described, including chemotherapy and supporting treatment (like granulocyte-colony stimulating factor in oncological patients. The evidence in favour of this pharmacological link is growing. The differential diagnosis of fever, in febrile neutropenia setting, can be difficult to itemize.
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21
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Taimen K, Heino S, Kohonen I, Relas H, Huovinen R, Hänninen A, Pirilä L. Granulocyte colony-stimulating factor- and chemotherapy-induced large-vessel vasculitis: six patient cases and a systematic literature review. Rheumatol Adv Pract 2020; 4:rkaa004. [PMID: 32128475 PMCID: PMC7046168 DOI: 10.1093/rap/rkaa004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Patients receiving chemotherapy are prone to neutropoenic infections, presenting with non-specific symptoms such as a high fever and elevated inflammatory parameters. Large-vessel vasculitis (LVV) may have a similar clinical presentation and should be included in differential diagnostics. A few published case reports and adverse event reports suggest a causal association between LVV and the use of granulocyte colony-stimulating factor (G-CSF) and chemotherapy. Our objective was to evaluate the relationship between LVV, G-CSF and chemotherapy. METHODS Between 2016 and 2018, we identified six patients in Finland with probable drug-induced LVV associated with G-CSF and chemotherapy. All six patients had breast cancer. A systematic literature review was performed according to PRISMA guidelines using comprehensive search terms for cancer, chemotherapy, G-CSF and LVV. RESULTS The literature search identified 18 similar published case reports, of which most were published after 2014. In all patients combined (n = 24), the time delay from the last drug administration to the LVV symptoms was on average 5 days with G-CSF (range = 1-8 days) and 9 days with chemotherapy (range = 1-21 days). Common symptoms were fever (88%), neck pain (50%) and chest pain (42%). Based on imaging, 17/24 (71%) had vascular inflammation in the thoracic aorta and supra-aortic vessels, but 5/24 (21%) reportedly had inflammation limited to the carotid area. CONCLUSION This review suggests that LVV may be a possible serious adverse event associated with G-CSF and chemotherapy. Successful management of drug-induced LVV requires early identification, through diagnostic imaging, and discontinuation of the drug.
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Affiliation(s)
- Kirsi Taimen
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku
- Department of Internal Medicine, University of Turku, Turku
| | - Samu Heino
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku
- Department of Internal Medicine, University of Turku, Turku
| | - Ia Kohonen
- Department of Radiology, Turku University Hospital, Turku
| | - Heikki Relas
- Department of Rheumatology, Helsinki University Hospital, Helsinki
| | - Riikka Huovinen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku
| | - Arno Hänninen
- Department of Clinical Microbiology and Immunology, Turku University Hospital, Turku, Finland
| | - Laura Pirilä
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku
- Department of Internal Medicine, University of Turku, Turku
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22
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Hoshina H, Takei H. Granulocyte-colony stimulating factor-associated aortitis in a woman with advanced breast cancer: a case report and review of the literature. BMC Cancer 2019; 19:1217. [PMID: 31842789 PMCID: PMC6915889 DOI: 10.1186/s12885-019-6403-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background Granulocyte-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 presentation A 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. Conclusions G-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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Affiliation(s)
- Hideko Hoshina
- Department of Breast Surgery and Oncology, Nippon Medical School, 1-1-5 Sendagi, Tokyo, Bunkyo, 113-8603, Japan. .,Department of Breast Surgery, Kikuna Memorial Hospital, Kikuna 4-4-27 Kouhoku, Yokohama, Kanagawa, 222-0011, Japan.
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School, 1-1-5 Sendagi, Tokyo, Bunkyo, 113-8603, Japan
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