A Case of Large-Vessel Vasculitis Caused by Pegfilgrastim during Neoadjuvant Chemotherapy for Breast Cancer

Abstract

A 73-year-old woman received doxorubicin and cyclophosphamide (AC) treatment as neoadjuvant chemotherapy for left breast cancer (cT4N0M0, Stage IIIB, luminal B). Pegfilgrastim was administered on day 5. The patient developed fever, headache, and pain in her right shoulder on day 14 and visited our hospital on day 16. The inflammatory response was high, and contrast-enhanced computed tomography (CECT) revealed wall thickening from the right innominate artery to the bilateral common carotid arteries and an increased density of the surrounding fat tissue. Tests for various infectious diseases were negative, and new-onset collagen disease was ruled out. Therefore, a diagnosis of granulocyte colony stimulating factor (G-CSF) -related large-vessel vasculitis was made and oral prednisolone administration (35 mg/d) was initiated on day 20. The symptoms and inflammatory response rapidly improved thereafter, and no signs of aortitis recurrence were observed, even after treatment was concluded. We decided to perform surgery first, with weekly paclitaxel administration, radiation, and hormone therapies administered postoperatively. G-CSF-related large-vessel vasculitis must be considered if fever and an increased inflammatory response are observed when using G-CSF preparations.