Granulocyte colony-stimulating factor- and chemotherapy-induced large-vessel vasculitis : six patient cases and a systematic literature review

Objective. Patients receiving chemotherapy are prone to neutropoenic infections, presenting with non-specific symptoms such as a high fever and elevated inflammatory parameters. Large-vessel vasculitis (LVV) may have a similar clinical presentation and should be included in differential diagnostics. A few published case reports and adverse event reports suggest a causal association between LVV and the use of granulocyte colony-stimulating factor (G-CSF) and chemotherapy. Our objective was to evaluate the relationship between LVV, G-CSF and chemotherapy. Methods. Between 2016 and 2018, we identified six patients in Finland with probable drug-induced LVV associated with G-CSF and chemotherapy. All six patients had breast cancer. A systematic literature review was performed according to PRISMA guidelines using comprehensive search terms for cancer, chemotherapy, G-CSF and LVV. Results. The literature search identified 18 similar published case reports, of which most were published after 2014. In all patients combined (n = 24), the time delay from the last drug administration to the LVV symptoms was on average 5 days with G-CSF (range = 1-8 days) and 9 days with chemotherapy (range = 1-21 days). Common symptoms were fever (88%), neck pain (50%) and chest pain (42%). Based on imaging, 17/24 (71%) had vascular inflammation in the thoracic aorta and supra-aortic vessels, but 5/24 (21%) reportedly had inflammation limited to the carotid area. Conclusion. This review suggests that LVV may be a possible serious adverse event associated with G-CSF and chemotherapy. Successful management of drug-induced LVV requires early identification, through diagnostic imaging, and discontinuation of the drug.Peer reviewe

Granulocyte colony-stimulating factor- and chemotherapy-induced large-vessel vasculitis: six patient cases and a systematic literature review

Patients receiving chemotherapy are prone to neutropoenic infections, presenting with non-specific symptoms such as a high fever and elevated inflammatory parameters. Large-vessel vasculitis (LVV) may have a similar clinical presentation and should be included in differential diagnostics. A few published case reports and adverse event reports suggest a causal association between LVV and the use of granulocyte colony-stimulating factor (G-CSF) and chemotherapy. Our objective was to evaluate the relationship between LVV, G-CSF and chemotherapy.MethodsBetween 2016 and 2018, we identified six patients in Finland with probable drug-induced LVV associated with G-CSF and chemotherapy. All six patients had breast cancer. A systematic literature review was performed according to PRISMA guidelines using comprehensive search terms for cancer, chemotherapy, G-CSF and LVV.ResultsThe literature search identified 18 similar published case reports, of which most were published after 2014. In all patients combined (n = 24), the time delay from the last drug administration to the LVV symptoms was on average 5 days with G-CSF (range = 1–8 days) and 9 days with chemotherapy (range = 1–21 days). Common symptoms were fever (88%), neck pain (50%) and chest pain (42%). Based on imaging, 17/24 (71%) had vascular inflammation in the thoracic aorta and supra-aortic vessels, but 5/24 (21%) reportedly had inflammation limited to the carotid area.ConclusionThis review suggests that LVV may be a possible serious adverse event associated with G-CSF and chemotherapy. Successful management of drug-induced LVV requires early identification, through diagnostic imaging, and discontinuation of the drug.</div

Chemotherapy and granulocyte colony-stimulating factor induced large vessel vasculitis and carotidynia : six patient cases and a systematic literature review

Six patients with breast cancer were identified who had suspected chemotherapy or G-CSF induced large vessel vasculitis (LVV) from the University Hospitals of Helsinki and Turku, Finland. This kind of adverse drug reaction is not generally known. The purpose of this article is to evaluate the rare connection of LVV and anticancer therapy by describing our patient cases and through a systematic review of the literature. Two separate systematic literature searches were conducted in MEDLINE via PubMed to find reports of cancer patients receiving chemotherapy or G-CSF or both, prior to onset of new LVV. The first search was performed in May 2018 by using comprehensive search terms for breast cancer, chemotherapy and LVV. The second search was performed in December 2018 to assess the connection between G-CSF and LVV by using comprehensive keywords for LVV and G-CSF. The first literature search identified 12 and the second search identified 4 patient cases matching our criteria. Two of the patients described in the literature were suffering from breast cancer and had very similar clinical representation as the cases presented in this paper. Large vessel vasculitis is a possible serious rare adverse event associated with chemotherapy and G-CSF. The signs and symptoms of LVV are non-specific, and this condition could be underdiagnosed and should be kept in mind when treating oncological patients. Successful management requires early identification and cessation of the drug. When diagnosed and treated properly, the recovery is usually fast

Intravesical Prostatic Protrusion and Prostatic Urethral Angle Correlate Better with Uroflowmetry Rates than Lower Urinary Tract Symptoms

Benign prostate hyperplasia (BPH) stands as one of the most common conditions of aging men, causing lower urinary tract symptoms (LUTS) and significantly affecting on their quality of life. Contrary to the common belief that prostate size correlates causally with the severity of LUTS, several studies have demonstrated the complexity and multifactorial focality of clinical BPH and LUTS. Currently, the assessment of BPH typically includes digital rectal examination (DRE), serum prostate-specific antigen (PSA) levels, a questionnaire charting the urinary symptoms and uroflowmetry. Transrectal ultrasound (TRUS) has traditionally been the primary imaging method for BPH patients. Magnetic resonance imagining (MRI) is a widely used imaging technique in the diagnosis of prostate cancer, but the role in evaluation of BPH has so far been limited. The aim of this study is to analyse the correlations between prostate MRI measurements, urinary symptom scores and uroflowmetry rates. In total, 419 participants with clinical suspicion of prostate cancer undergoing prostate MRI were included in this retrospective study. EPIC-26 questionnaire was collected from the participants to chart their urinary symptoms. In addition, uroflowmetry were performed on 128 participants. A total of eight different MRI-derived parameters were measured, which had been suggested as possible independent factors of BPH in the previous literature: Total prostate volume (TPV), transition zone volume (TZV), TZ index (TZI), anterior fibromuscular stroma (AFMS) distance, intravesical prostate protrusion (IPP), prostatic urethral angle (PUA), bladder wall thickness (BWT) and urethral wall thickness (UWT). The data was analysed, and it was found that TPV, TZV, TZI, AFMS distance, IPP and PUA exhibited significant, independent but weak correlations with urinary symptom scores and uroflowmetry rates However, the correlations seem to be weaker than previously estimated. IPP and PUA correlate better with uroflowmetry rates than urinary symptom scores, whereas prostate parameters describing the size of the prostate correlate equally with both.Eturauhasen hyvänlaatuinen liikakasvu (BPH) on yksi yleisimmistä ikääntyvien miesten sairauksista, ja se voi aiheuttaa alavirtsatieoireita, jotka taudin edetessä heikentävät merkittävästi elämänlaatua. Yleinen käsitys on ollut, että eturauhasen koon kasvaminen itsessään selittäisi alavirtsatieoireiden syntyä, mutta oireiden kehittymiseen saattaa tämän lisäksi liittyä muitakin patofysiologisia mekanismeja, joita vieläkään ei täysin tunneta. Eturauhasen liikakasvun diagnostiikka perustuu tällä hetkellä tuseeraustutkimukseen, PSA-arvon mittaamiseen, virtsaamisoireiden kartoittamiseen ja virtsan virtaamamittaukseen. Eturauhasen morfologian arviointiin käytetään yleisimmin ultraäänitutkimusta peräsuolen kautta (TRUS). Magneettikuvaus (MRI) on osoittautunut erinomaiseksi kuvantamismenetelmäksi muun muassa eturauhassyövän diagnostiikassa hyvän pehmytkudoserottelukykynsä ansiosta, mutta sen käyttö eturauhasen hyvänlaatuisen liikakasvun ja virtsaamisvaivojen arvioinnissa on ollut toistaiseksi vähäistä. Tämän tutkimuksen tavoitteena on tutkia MRI-kuvista mitattavien parametrien korrelaatiota virtsaamisoirekyselyn pisteisiin ja virtsan virtausmittaustuloksiin. Aineisto koostui 435 miehestä, joilla oli kliininen eturauhassyöpäepäily, minkä vuoksi heille tehtiin eturauhasen magneettikuvaus. Tutkittavilta kerättiin EPIC-26-kyselykaavake, jonka perusteella alavirtsatieoireita kartoitettiin. Lisäksi 128 osallistujaa oli käynyt virtsan virtaamamittauksessa. Magneettikuvista mitattiin yhteensä kahdeksan erilaista parametria, joita oli aiemmassa alan kirjallisuudessa esitetty liikakasvun oireita aiheuttaviksi tekijöiksi: eturauhasen kokonaistilavuus (TPV), eturauhasen keskilohkon tilavuus (TZV), eturauhasen keskilohkon osuus kokonaistilavuudesta (TZI), anteriorisen fibromuskulaarisen strooman (AFMS) pituus, eturauhasen intravesikaalinen ulkonema (IPP), virtsaputken etu-rauhasosan kulmamitta (PUA), virtsaputken eturauhasosan paksuus (UWT) ja rakon seinämän paksuus (BWT). Aineistoa analysoitiin ja todettiin, että TPV, TZV, TZI, AFMS-mitta, IPP ja PUA korreloivat merkitsevästi ja itsenäisesti virtsaamisoirepisteisiin ja virtsan virtaamaan, mutta korrelaatiokertoimet olivat heikompia kuin aiemmin oli kuvattu. IPP ja PUA näyttivät korreloivan paremmin virtsan virtaamaan kuin oirepisteisiin, kun taas eturauhasen kokoa paremmin kuvaavat parametrit korreloivat yhtä lailla kumpaankin