Matsumoto Maki, Takakura Hidetomo, Usui Yuichiro, Sugimoto Takeshi, Yabe Moemi, Misaki Kenta, Kawaguchi Koji
Department of Hematology and Oncology, Kita-Harima Medical Center.
Department of Rheumatology, Kita-Harima Medical Center.
Rinsho Ketsueki. 2023;64(10):1270-1274. doi: 10.11406/rinketsu.64.1270.
A 75-year-old man was diagnosed with diffuse large B-cell lymphoma originating from the paranasal sinuses. Curative induction chemotherapy was initiated and pegfilgrastim was administered on day5 of the first cycle as primary prophylaxis. The patient developed headache on day7 and fever on day11. These symptoms persisted despite treatment with antibiotics and antifungal agents. Computed tomography (CT) after admission revealed wall thickening in the aortic arch. Chest contrast-enhanced CT also revealed contrast enhancement in the thickened aortic wall. Results of blood cultures and serological tests for autoantibodies were negative, indicating that the clinical manifestations were not due to infection or a specific collagen disease. The final diagnosis was drag-induced large vessel vasculitis induced by long-acting granulocyte colony-stimulating factor (G-CSF). The patient's symptoms and large-vessel wall thickening immediately resolved after treatment with a glucocorticoid (prednisolone, 0.6 mg/kg/day). Aortitis should be considered as a differential diagnosis when fever is observed in a patient who received long-acting G-CSF during chemotherapy.
一名75岁男性被诊断为起源于鼻窦的弥漫性大B细胞淋巴瘤。开始进行根治性诱导化疗，并在第一个周期的第5天给予培非格司亭作为一级预防。患者在第7天出现头痛，第11天出现发热。尽管使用了抗生素和抗真菌药物治疗，这些症状仍持续存在。入院后计算机断层扫描（CT）显示主动脉弓壁增厚。胸部增强CT也显示增厚的主动脉壁有强化。血培养和自身抗体血清学检测结果均为阴性，表明临床表现并非由感染或特定的胶原病引起。最终诊断为长效粒细胞集落刺激因子（G-CSF）诱导的药物性大血管血管炎。使用糖皮质激素（泼尼松龙，0.6mg/kg/天）治疗后，患者的症状和大血管壁增厚立即消失。在化疗期间接受长效G-CSF治疗的患者出现发热时，应考虑将主动脉炎作为鉴别诊断。
