Caught in the Crossfire: A Case of Splenic Infarction Amid G-CSF therapy in Chronic Myelomonocytic Leukaemia

This report highlights a rare but significant complication associated with the use of granulocyte-colony stimulating factor (G-CSF) therapy, specifically splenic infarction, in a 67-year-old male with chronic myelomonocytic leukaemia (CMML) undergoing chemotherapy. G-CSFs, such as pegfilgrastim, are frequently used to prevent febrile neutropenia in cancer patients undergoing myelotoxic chemotherapy. While G-CSF is effective in reducing the risk of neutropenia, its administration has been linked to uncommon but severe complications such as splenic infarction and rupture. Our patient, receiving dose-dense chemotherapy with G-CSF support, developed severe abdominal pain midway through treatment. A computed tomography (CT) scan revealed multiple splenic hypodensities consistent with splenic infarction, but no active bleeding. Conservative management was successfully employed, avoiding surgical intervention. This case underscores the need for vigilance when administering G-CSF, particularly in patients at high risk for complications, and contributes to the limited body of literature on G-CSF-induced splenic infarction.

Clinical vigilance in G-CSF therapy This report highlights the need for heightened awareness of rare but severe complications, such as splenic infarction, associated with granulocyte-colony stimulating factor (G-CSF) therapy. Internists managing patients on chemotherapy must recognise early signs of such complications to optimise patient outcomes.Risk-benefit assessment It emphasises the importance of individualised treatment strategies, balancing the lifesaving benefits of G-CSF in preventing febrile neutropenia with the potential risks, particularly in patients with predisposing conditions such as chronic myelomonocytic leukaemia (CMML).Conservative management insights The successful non-surgical management of splenic infarction in this case underscores the potential for conservative approaches, providing valuable guidance for internists in similar clinical scenarios.