From Aortitis to Sweet's: The Immune Spectrum of G-CSF Adverse Events. (PubMed, Semin Arthritis Rheum)
Exogenous G-CSF can precipitate a coherent spectrum of immune-mediated toxicity with distinct, clinically actionable timing windows: vascular events peak 7-15 days after pegfilgrastim, whereas cutaneous, articular, and pulmonary manifestations arise within 2-7 days. Recognition hinges on temporal linkage, imaging/histology, and exclusion of mimics. Management is phenotype-aware-drug withdrawal ± short glucocorticoids, formulation switching for CPPD, and targeted IL-6 blockade in selected refractory aortitis-allowing preservation of hematologic benefits while minimizing immune toxicity. Prospective surveillance and structured re-exposure studies (including formulation tailoring) are priorities to move from signal detection to prevention.