内容紹介
Summary
A 61-year-old woman presented with metastatic breast cancer in her right lung 4 years and 11 months after the operation for her right breast cancer(HER2 enriched type). Chemotherapy(pertuzumab plus trastuzumab plus docetaxel)were administered. On day 2 of cycle 2, pegfilgrastim was administered because her neutrophils decreased to 54 cells/μL on day 8 of cycle 1. On day 9 of cycle 2, she developed left neck and chest pain. Moreover, she developed a fever of 39℃ on day 14 and visited our hospital. Her WBC and CRP increased to 18,300 cells/μL and 25.48 mg/dL, respectively. Computed tomography revealed an increased CT value of the panniculus, around the aorta and left pleural effusion. Ultrasonography of the neck showed a marginal hypoechoic area around the left carotid artery, which corresponded with the pain. Arteritis induced by PFG was suspected. The neck pain and fever almost completely improved 19 days later, and cycle 3 was performed 28 days after cycle 2. To our knowledge, the present case is the second report of arteritis that was suspected to be associated with PFG.
要旨
症例は61歳,女性。右乳癌(HER2 enriched type)術後4年11か月で右肺転移を認め,pertuzumab+trastuzumab+docetaxel療法を開始した。1コース目でGrade 4の好中球減少を認め,2コース目施行後2日目にpegfilgrastim(PFG)を投与した。9日目より左頸胸部痛が出現し,14日目に39℃の発熱を認め,外来受診した。白血球18,300/μL(好中球17,000/μL),CRP 25.48 mg/dLと著明な上昇を認め,胸部CTで胸部大動脈周囲の濃度上昇を認めた。頸部超音波で疼痛部位に一致して総頸動脈周囲の低エコー域を認め,PFGによる動脈炎の可能性が考えられた。アセトアミノフェン内服で経過観察としたが,19日目に解熱,頸部痛も改善した。G-CSF製剤はサイトカイン放出促進作用を有し,その使用による動脈炎の発症や悪化が報告されており,G-CSF製剤使用の際には留意すべきと考えられる。
目次
A 61-year-old woman presented with metastatic breast cancer in her right lung 4 years and 11 months after the operation for her right breast cancer(HER2 enriched type). Chemotherapy(pertuzumab plus trastuzumab plus docetaxel)were administered. On day 2 of cycle 2, pegfilgrastim was administered because her neutrophils decreased to 54 cells/μL on day 8 of cycle 1. On day 9 of cycle 2, she developed left neck and chest pain. Moreover, she developed a fever of 39℃ on day 14 and visited our hospital. Her WBC and CRP increased to 18,300 cells/μL and 25.48 mg/dL, respectively. Computed tomography revealed an increased CT value of the panniculus, around the aorta and left pleural effusion. Ultrasonography of the neck showed a marginal hypoechoic area around the left carotid artery, which corresponded with the pain. Arteritis induced by PFG was suspected. The neck pain and fever almost completely improved 19 days later, and cycle 3 was performed 28 days after cycle 2. To our knowledge, the present case is the second report of arteritis that was suspected to be associated with PFG.
要旨
症例は61歳,女性。右乳癌(HER2 enriched type)術後4年11か月で右肺転移を認め,pertuzumab+trastuzumab+docetaxel療法を開始した。1コース目でGrade 4の好中球減少を認め,2コース目施行後2日目にpegfilgrastim(PFG)を投与した。9日目より左頸胸部痛が出現し,14日目に39℃の発熱を認め,外来受診した。白血球18,300/μL(好中球17,000/μL),CRP 25.48 mg/dLと著明な上昇を認め,胸部CTで胸部大動脈周囲の濃度上昇を認めた。頸部超音波で疼痛部位に一致して総頸動脈周囲の低エコー域を認め,PFGによる動脈炎の可能性が考えられた。アセトアミノフェン内服で経過観察としたが,19日目に解熱,頸部痛も改善した。G-CSF製剤はサイトカイン放出促進作用を有し,その使用による動脈炎の発症や悪化が報告されており,G-CSF製剤使用の際には留意すべきと考えられる。