Aortitis triggered by granulocyte-colony stimulating factor

A man in his sixties was diagnosed with diffuse large B-cell lymphoma localised in the base of his tongue.

The patient was admitted to the emergency department with a fever, generalised muscle aches and lethargy 12 days atter receiving his first chemotherapy treatment with granulocyte-colony stimulating factor (G-CSF) supplementation. There were no focal signs of infection. The patient was started on empiric antibiotic treatment. After four days, C-reactive protein (CRP) had increased from 104 to 331, but the patient's condition was largely unchanged. A computer tomography (CT) scan showed aortitis, most likely caused by G-CSF. The patient was treated with prednisolone and rapidly improved.

The diagnosis of G-CSF-induced aortitis should be considered in patients with fever after G-CSF treatment, particularly if adequate antibiotic treatment does not lead to improvement. Advanced imaging is often indicated. The most important measure is to discontinue G-CSF supplementation.