G-CSF-induced Aortitis in an elderly woman successfully managed with prednisolone: a case report and literature review.

Cancer incidence among old is increasing. Since age is important risk factor for febrile neutropenia (FN), use of granulocyte-colony stimulating factor (G-CSF) and its complication is clinically important. A 72-year old woman has completed definitive surgery for left breast cancer and was started on postoperative chemotherapy. After 12 doses of paclitaxel, she received 1st cycle of epirubicin and cyclophosphamide (day 1), and pegfilgrastim, a pegylated G-CSF to decrease the risk of FN (day 2). On day 13, she was admitted due to persistent fever since day 9. Laboratory tests revealed elevated neutrophil counts and C-reactive protein. Despite empirical antibiotics, her fever persisted and severe back pain developed (day 15). Contrast-enhanced computed tomography revealed wall thickening and increased density around the aortic arch and brachiocephalic artery. Diagnosis of pegfilgrastim-induced vasculitis was made after excluding autoimmune vasculitis. Prednisolone (60 mg/day) was administered and the fever and back pain subsided the following day.