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

Area of Science:

• Vascular Medicine
• Adverse Drug Events
• Rheumatology

Background:

• A 73-year-old woman with myelodysplastic syndrome received granulocyte colony-stimulating factor (G-CSF) for chemotherapy-induced neutropenia.
• Five days post-injection, she developed odynophagia, fever, and neck swelling.

Observation:

• Clinical examination revealed painful neck swelling.
• Laboratory tests showed significant inflammation (CRP 328 mg/L).
• CT and ultrasound imaging demonstrated thickening and infiltration around the left carotid artery and aortic arch.

Findings:

• The patient was diagnosed with G-CSF-induced large vessel vasculitis, specifically transient perivascular inflammation of the carotid artery (TIPIC) syndrome.
• Symptoms significantly improved spontaneously within a short period without corticosteroid treatment.
• Follow-up ultrasound confirmed reduced arterial wall thickening.

Implications:

• This case highlights a rare adverse reaction to G-CSF, emphasizing the importance of considering TIPIC syndrome.
• Physicians should be aware of G-CSF-induced TIPIC syndrome to avoid continued exposure to the causative agent.
• Early diagnosis and discontinuation of G-CSF can lead to rapid symptom resolution, potentially avoiding unnecessary treatments like corticosteroids.