Ioannis Parodis1, Lara Dani2, Antonella Notarnicola2, Git Martenhed3, Pontus Fernström4, Alexios Matikas5, Oscar P B Wiklander6. 1. Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: ioannis.parodis@ki.se. 2. Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Stockholm, Sweden. 3. Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Radiology, Karolinska University Hospital, Stockholm, Sweden. 5. Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Oncology/Pathology Department, Karolinska Institutet, Stockholm, Sweden. 6. HHLH Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: oscar.wiklander@ki.se.
Abstract
BACKGROUND: Febrile neutropenia is generally recognised as a complication of myelosuppressive chemotherapy. Recombinant human granulocyte colony stimulating factor (G-CSF) is commonly used as a primary or secondary prophylaxis to reduce the degree and duration of neutropenia in patients at risk of developing chemotherapy-induced neutropenic fever and infectious complications. G-CSF is known to decrease mortality and increase the possibility of maintaining adequate chemotherapy dose intensity and density, which is essential in curable malignancies. Common side effects are generally mild. However, potentially fatal adverse events have also been reported. CASE PRESENTATION: Herein, we summarise previously reported and report two new independent cases of G-CSF-induced aortitis, both in patients treated with chemotherapy for breast cancer. The two cases, identified only a few months apart, share several common characteristics including type of cancer, gender, age, chemotherapy, G-CSF treatment regimen, and time span from G-CSF initiation to aortitis manifestation. The two cases were both diagnosed by CT scan and successfully treated with corticosteroids along with discontinuation of G-CSF. CONCLUSION: This case report highlights that although aortitis is a rare adverse event of G-CSF treatment, it should be considered in cases of unexplained fever and/or clinical and laboratory findings that do not respond to antibiotics.
BACKGROUND:Febrile neutropenia is generally recognised as a complication of myelosuppressive chemotherapy. Recombinant humangranulocyte colony stimulating factor (G-CSF) is commonly used as a primary or secondary prophylaxis to reduce the degree and duration of neutropenia in patients at risk of developing chemotherapy-induced neutropenic fever and infectious complications. G-CSF is known to decrease mortality and increase the possibility of maintaining adequate chemotherapy dose intensity and density, which is essential in curable malignancies. Common side effects are generally mild. However, potentially fatal adverse events have also been reported. CASE PRESENTATION: Herein, we summarise previously reported and report two new independent cases of G-CSF-induced aortitis, both in patients treated with chemotherapy for breast cancer. The two cases, identified only a few months apart, share several common characteristics including type of cancer, gender, age, chemotherapy, G-CSF treatment regimen, and time span from G-CSF initiation to aortitis manifestation. The two cases were both diagnosed by CT scan and successfully treated with corticosteroids along with discontinuation of G-CSF. CONCLUSION: This case report highlights that although aortitis is a rare adverse event of G-CSF treatment, it should be considered in cases of unexplained fever and/or clinical and laboratory findings that do not respond to antibiotics.