G-CSF-induced TIPIC syndrome and large vessel vasculitis: A case report

We report a rare adverse event of transient perivascular inflammation of the carotid artery syndrome induced by granulocyte colony-stimulating factor injections. Recognition of this syndrome is important for physicians, to avoid the exposure of the causative medication, rule out differential diagnosis and delay the use of corticosteroids given the spontaneous improvement after discontinuation of the causative medication.

A 73 year-old Caucasian woman presented with odynophagia, carotidynia, and fever 5 days following a granulocyte colony-stimulating factor (G-CSF) injection for chemotherapy-induced neutropenia in the setting of myelodysplastic syndrome. Examination showed painful swelling of the neck. Lab results showed inflammation with CRP 328 mg/L. A CT-scan revealed tissue infiltration thickening surrounding the left internal carotid artery, the carotid bifurcation, and the common carotid artery, as well as circumferential thickening of the aortic arch. Ultrasound of the left internal carotid artery found isoechoic wall thickening. Symptoms drastically improved without steroids in a short time period. Horton's disease, Takayasu's diseases, and infectious vasculitis were not retained due to the short time delay of symptoms onset, atypical echogenicity, and spontaneous improvement. A diagnosis of G-CSF-induced large vessel vasculitis transient perivascular inflammation of the carotid artery (TIPIC) syndrome was made. Seven days later, ultrasound control showed diminished thickening infiltration. G-CSF TIPIC is a rare adverse event that should be kept in mind in patients under G-CSF.