Granulocyte colony-stimulating factor-induced aortitis with temporal arteritis and monoarthritis

Area of Science:

• Oncology
• Rheumatology
• Vascular Medicine

Background:

• Gemcitabine-cisplatin chemotherapy is a standard treatment for bladder cancer.
• Neutropenia is a common side effect of chemotherapy, often managed with granulocyte colony-stimulating factor (G-CSF).

Observation:

• An elderly patient undergoing chemotherapy for bladder cancer developed neutropenia and was treated with G-CSF.
• The patient subsequently presented with fever, jaw claudication, and knee arthritis, with CT scans revealing aortitis.

Findings:

• The patient was diagnosed with G-CSF-induced aortitis and treated with prednisolone, leading to rapid symptom resolution and normalization of inflammatory markers.
• Despite initial improvement, the patient experienced a relapse of knee arthritis upon early discontinuation of prednisolone, suggesting a recurrence of G-CSF-induced arthritis.

Implications:

• G-CSF-induced aortitis can manifest with peripheral symptoms beyond the aorta and major arteries, including temporal arteritis and arthritis.
• Prompt treatment with prednisolone is effective for G-CSF-induced aortitis, but prolonged treatment may be necessary to prevent relapse, as demonstrated by the patient's recurrent arthritis.
• This case highlights the importance of considering G-CSF-induced aortitis in patients presenting with inflammatory symptoms during chemotherapy and the potential need for extended corticosteroid therapy.