A Case of Aortitis after Administration of G-CSF during Neoadjuvant Chemotherapy for Breast Cancer

Abstract

Prophylactic administration of G-CSF is recommended for patients with a high risk of febrile neutropenia during cancer chemotherapy. On the other hand, the G-CSF administration entails a risk of associating aortitis in 0.47-2.7% of G-CSF cases that is recently given an attention. We report a case of aortitis after multiple doses of pegfilgrastim, a long-acting G-CSF, including a review of the literature. The patient was a 53-year-old woman with right breast cancer. She completed 4 courses of dose-dense (dd) EC and 1 course of dd-paclitaxel with pegfilgrastim as neoadjuvant chemotherapy (NAC) without severe adverse events. However, after receiving the second course of dd-paclitaxel with pegfilgrastim, she developed fever and right lower abdominal pain. Two weeks later, the inflammatory response remained, and a CT scan showed inflammation around the aorta, which led to a suspicion of G-CSF-associated aortitis. After symptomatically treated with antipyretic and analgesic drugs and without steroids, her clinical symptoms were improved. Right breast-conserving surgery was then performed due to the evidence of complete response to NAC from a CT scan. After surgery, she no longer had symptoms associated with aortitis, and a follow-up CT scan on postoperative day 42 showed no evidence of aortitis. We must remain alert for possible association of G-CSF-induced aortitis following multiple administrations even after a safe initial one.