A case of aortitis during cisplatin-based chemotherapy for cervical cancer

Webb, Katharine; Prakash, Vineet; Kirresh, Othman; Stewart, Alexandra J.

doi:10.1259/bjrcr.20180054

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…A chemotherapy-related aortitis remains the most likely explanation, given the lack of other positive findings and risk factors. There are several case reports describing associations between vasculitis and platinum-based chemotherapy agents; one reports a case of aortitis during cisplatin-based chemotherapy [11]; another describes two cases of leukocytoclastic (small-vessel) vasculitis during oxaliplatin-based chemotherapy [12]. In all of these cases, levels of autoantibodies and immunoglobulins were within the normal ranges.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Aortic Haematoma in a Patient Receiving Adjuvant Folinic Acid, 5-Fluorouracil, Irinotecan, and Oxaliplatin Chemotherapy Following Resection of a Pancreatic Adenocarcinoma

Dacie

Woodhouse

Mullan

et al. 2020

Cureus

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This case report describes the finding of a spontaneous aortic haematoma in a patient receiving adjuvant folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) chemotherapy following resection of a pancreatic adenocarcinoma. The haematoma was thought to have arisen secondary to a chemotherapyinduced vasculitis affecting the aorta, as the patient had no other risk factors for de novo aortitis or aortic haematoma. There have been several previously documented cases of associations between chemotherapy agents (in particular platinum-based agents) and vasculitis. This report includes computed tomography (CT) images and a discussion of the literature of related cases. This case is a good example of rare vascular toxicities arising from chemotherapy, the impact such rare complications have upon further chemotherapy options, and how these should be discussed when consenting patients for chemotherapy due to the potentially life-threatening complications.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Aortic Haematoma in a Patient Receiving Adjuvant Folinic Acid, 5-Fluorouracil, Irinotecan, and Oxaliplatin Chemotherapy Following Resection of a Pancreatic Adenocarcinoma

Dacie

Woodhouse

Mullan

et al. 2020

Cureus

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“…While there have been some reports in the literature, medication-induced aortitis remains an exceedingly rare entity. Webb et al describe a case of aortitis secondary to cisplatin chemotherapy for stage IVB cervical cancer, while Koyama et al identify granulocyte colony-stimulating factor as the trigger for aortic arch aortitis in a patient with triplenegative breast cancer [7,8] . Immune checkpoint inhibitor-induced aortitis and/ or peraortitis is becoming increasingly evident, and its presentation can vary.…”

Section: Discussionmentioning

confidence: 99%

A cautionary note on pembrolizumab use in patients with ascending aortic aneurysms

Khan,

Ahern,

Prendergast

et al. 2024

European Journal of Case Reports in Internal Medicine

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Case description: We describe a case of a patient treated with pembrolizumab (an immune checkpoint inhibitor) for metastatic scalp melanoma. He had a previous history of colorectal cancer, prostatic cancer and chronic polymyalgia rheumatica. The patient was known to have a stable ascending aortic aneurysm of 4.5 cm. However, he developed a rapid expansion of the ascending aortic aneurysm with the size crossing the threshold for surgery. The patient was referred to the cardiothoracic surgery service for intervention and he subsequently underwent surgery. The patient was electively admitted one week later for resection of aortic aneurysm, aortoplasty and external graft fixation. Pathologically, gross evidence of dissection was not identified; however, the histological analysis of the media showed laminar medial necrosis, multifocal in nature, with occasional clusters of histiocytic cells appreciated at their edge reminiscent of that seen in an inflammatory aortitis (granulomatous/giant cell type). Discussion: Immune checkpoint inhibitor-induced aortitis is becoming increasingly evident, and its presentation can vary. It has been discovered incidentally on surveillance imaging with the use of nivolumab. In other cases, patients have been symptomatic to severely symptomatic. Atezolizumab with carboplatin and etoposide has been reported to cause abdominal aortitis which was responsive to corticosteroids and subsequent discontinuation of atezolizumab. Pembrolizumab has been linked to a case of transverse aortic arch aortitis. In our case, the inflammatory aortitis due to pembrolizumab was the cause of the rapid expansion of the ascending aortic aneurysm. Conclusion: Patients with known aortic aneurysms should undergo careful surveillance when commencing immune-checkpoint inhibitor therapy.

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“… 9 Cisplatin-based chemotherapy induces acute and transient endothelial dysfunction, dyslipidemia, and hyperglycemia during the early phases of treatment. 1 Furthermore, cisplatin-based chemotherapy may cause aortitis 10 and may lead to endothelial injury/dysfunction. These mechanisms infer development of various thromboembolic events including aortic thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery embolism associated with Cisplatin-induced aortic thrombosis

Aoki,

Kato,

Nakajima

et al. 2023

BJR|case reports

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Cardiovascular complications of cancer therapy are among the most important factors affecting cancer prognosis. Cisplatin-induced aortic thrombosis is rare but can be life-threatening in the event of peripheral embolism. In this report, we describe a case of superior mesenteric artery (SMA) embolism associated with cisplatin-induced aortic thrombosis. A 66-year-old male, diagnosed with esophageal cancer, initiated systemic chemotherapy with a regimen consisting of 5-fluorouracil and cisplatin, combined with radiotherapy. After 7 days of chemoradiotherapy, the patient developed a floating thrombus in the ascending aorta and an SMA embolism; chemoradiotherapy was then discontinued. Laparoscopy revealed an ischemic small intestine that required resection; intravenous unfractionated heparin was initiated 3 days after. Computed tomography showed disappearance of the floating aortic thrombus and reduce SMA thrombus size. Early detection of cisplatin-induced aortic thrombosis may prevent fatal outcomes in symptomatic peripheral embolisms, such as SMA embolism, considering anticoagulation, and discontinuation of cisplatin-based chemotherapy may cause resolution of thrombus events.

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A case of aortitis during cisplatin-based chemotherapy for cervical cancer

Cited by 5 publications

References 25 publications

Spontaneous Aortic Haematoma in a Patient Receiving Adjuvant Folinic Acid, 5-Fluorouracil, Irinotecan, and Oxaliplatin Chemotherapy Following Resection of a Pancreatic Adenocarcinoma

Spontaneous Aortic Haematoma in a Patient Receiving Adjuvant Folinic Acid, 5-Fluorouracil, Irinotecan, and Oxaliplatin Chemotherapy Following Resection of a Pancreatic Adenocarcinoma

A cautionary note on pembrolizumab use in patients with ascending aortic aneurysms

Superior mesenteric artery embolism associated with Cisplatin-induced aortic thrombosis

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