Large vessel vasculitis post granulocyte-colony stimulating factor (G-CSF) use in a patient undergoing neoadjuvant chemotherapy for pancreatic adenocarcinoma

We report a case of radiologically confirmed large vessel vasculitis (LVV) in a woman in her 70s undergoing neoadjuvant FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, oxaliplatin) chemotherapy for borderline resectable pancreatic adenocarcinoma. The patient presented with fever and raised C reactive protein (CRP) shortly after completing her third cycle of chemotherapy. Infection and vasculitis screens were negative. CT and positron emission tomography CT scans showed shrinkage of the primary cancer but changes consistent with LVV. Granulocyte-colony stimulating factor (G-CSF), felt to be the most likely causative agent, was discontinued and the patient started high dose prednisolone, with a prolonged weaning course. At the 6-week follow-up, there was complete resolution of her LVV on CT and normalisation of CRP. She successfully completed her remaining cycles of chemotherapy without G-CSF, and her presentation did not recur. However, her pancreatic cancer remained inoperable, and she sadly died from cancer progression 18 months later.