Large-vessel vasculitis induced by pegfilgrastim.

Area of Science:

• Oncology
• Immunology
• Rheumatology

Background:

• Granulocyte colony-stimulating factor (G-CSF) is a standard supportive care agent in chemotherapy to prevent febrile neutropenia.
• Large-vessel vasculitis (LVV) is a rare but recognized adverse event associated with G-CSF therapy.

Observation:

• A 56-year-old woman with breast cancer developed fever after receiving pegfilgrastim, a long-acting G-CSF.
• Contrast-enhanced CT revealed aortic arch and subclavian artery wall thickening, indicative of LVV.
• Other causes of vasculitis, including paraneoplastic, infectious, and autoimmune etiologies, were excluded.

Findings:

• The patient was diagnosed with G-CSF associated large-vessel vasculitis.
• Treatment with corticosteroids led to significant clinical improvement and radiological resolution of aortitis.

Implications:

• Clinicians should consider G-CSF induced LVV in patients presenting with suggestive symptoms after pegfilgrastim administration.
• Prompt recognition and management with immunosuppression can lead to favorable outcomes.
• Further research into the pathogenic mechanisms of G-CSF associated vasculitis is warranted.