Pegfilgrastim-associated large-vessel vasculitis developed during adjuvant chemotherapy for breast cancer: A case report and review of the literature

J Oncol Pharm Pract. 2020 Oct;26(7):1785-1790. doi: 10.1177/1078155220910800. Epub 2020 Mar 18.

Abstract

Introduction: Granulocyte colony-stimulating factor (G-CSF) is widely used as a neutrophil supportive therapy in breast cancer chemotherapy. Common adverse events of G-CSF include bone pain, headache, and fatigue; however, reports of G-CSF-associated vasculitis are few.

Case report: A 66-year-old woman who had undergone surgery for breast cancer received adjuvant chemotherapy with prophylactic use of pegfilgrastim (peg-G). She developed peg-G-associated vasculitis 11 days after initially receiving peg-G.Management and outcome: Although various blood and culture tests were required to rule out other vasculitis syndromes and infections, her symptoms spontaneously disappeared without any treatment other than discontinuation of the causal drug.

Discussion: G-CSF-associated vasculitis is occasionally accompanied by severe complications such as aortic dissection and aneurysm formation. This case report is important to draw attention towards this rare and difficult-to-diagnosis adverse event of peg-G.

Keywords: Adverse event; aortitis; arteritis; granulocyte colony-stimulating factor; side effect.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Breast Neoplasms / drug therapy*
  • Chemotherapy, Adjuvant
  • Female
  • Filgrastim / administration & dosage
  • Filgrastim / adverse effects*
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Humans
  • Polyethylene Glycols / administration & dosage
  • Polyethylene Glycols / adverse effects*
  • Vasculitis / chemically induced*

Substances

  • Granulocyte Colony-Stimulating Factor
  • pegfilgrastim
  • Polyethylene Glycols
  • Filgrastim