We report a case of aortic arteritis associated with granulocyte colony-stimulating factor (G-CSF) administration during neoadjuvant chemotherapy for breast cancer. The patient, a 62-year-old woman, underwent treatment for human epidermal growth factor receptor 2 (HER2)-positive left invasive ductal carcinoma. Eleven days after receiving pegfilgrastim (3.6 mg) for febrile neutropenia prophylaxis, she developed fever and chest pain. Despite a five-day course of oral levofloxacin, the symptoms persisted, prompting emergency transportation to our hospital.
Contrast-enhanced computed tomography (CT) revealed aortic wall thickening and perivascular fat stranding. After excluding infectious arteritis and primary vasculitis, we diagnosed pegfilgrastim-induced aortitis. Corticosteroid therapy with prednisolone (40 mg/day) was initiated on Day 11 after symptom onset, resulting in rapid defervescence and decreased inflammatory marker levels. The corticosteroid dose was gradually tapered and discontinued on Day 57, with no recurrence of vasculitis. Due to the risk of relapse associated with further G-CSF exposure, neoadjuvant chemotherapy was discontinued, and surgical treatment for breast cancer was performed.
G-CSF-associated aortitis is a rare adverse event, with an estimated incidence of approximately 0.47%. It typically presents within 10 days of G-CSF administration and manifests as fever, and chest or neck pain. This condition has been more frequently reported in Asia, particularly in Japan, and mostly affects women. Laboratory findings are generally non-specific, often showing leukocytosis and an elevated C-reactive protein level. Diagnosis is established primarily using contrast-enhanced CT.
While corticosteroid therapy is often effective, some patients have spontaneous remission. As a result, optimal indications, dosage, and tapering strategies for corticosteroid use remain unclear. The prognosis is generally favorable, although serious complications such as aortic dissection have been reported. The case reported here represents a typical clinical course for a patient with G-CSF-associated aortitis. In patients developing fever during chemotherapy, it is essential to consider a broad differential diagnosis, including G-CSF-associated aortitis.
