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Various toxicities: case report A 56-year-old man developed neutrophilic eccrine hidradenitis during treatment with doxorubicin, ifosomide and pegfilgrastim. Additionally, he developed aortitis, lung injury and splenomegaly during treatment with pegfilgrastim [not all routes stated]. The man, who had local recurrence of extraosseous mucinous chondrosarcoma on his right lower limb, presented with an 8-day history of high fever, general fatigue, and a rash with pain. He had finished the first 4-day course of chemotherapy with 2-day doxorubicin [adriamycin] 25 mg/m2 each and 4-day ifosfamide 2.8 g/m2 followed 36 hours later by SC pegfilgrastim [pegylated granulocyte colony-stimulating factor] 3.6mg. After 4 days, the he started developing current symptoms. At the presentation, he was alert and oriented. His vital investigations showed the following: BP 90/47mm Hg, pulse rate 95 beats/min, body temperature 39.1°C, respiratory rate 12 /min and oxygen saturation 99% on room air. A physical examination showed palm-sized dark red-topurplish indurated rashes with tenderness on the right cubital fossa and over the left knee socket (neutrophilic eccrine hidradenitis). Laboratory data showed the following: WBC 15780 /µL, haemoglobin 11.8 g/dL, platelet count 109000 /µL and serum C-reactive protein 38.77 mg/dL. A CT without contrast media showed inflammatory changes in the soft tissue surrounding the aorta, partial reticular change and ground-glass opacities scattered throughout both lungs and splenomegaly. Subsequently, he was found to have systemic inflammatory response syndrome and acute renal failure caused by bacterial infection. Thus, he was treated with crystalloid infusion for resuscitation and empirical piperacillin/tazobactam. Eventually, his renal function was restored; however, his high-grade fever persisted for 4 days, as did the inflammatory markers, despite piperacillin/tazobactam treatment. Furthermore, even with a high grade fever, his pulse rate had stayed in the range between 60 /min to 70 /min, which represented relative bradycardia and it has been considered a characteristic of drug related fever. Based on these findings, he was diagnosed with pegfilgrastim associated aortitis. The man started receiving treatment with prednisolone on day 4 of hospital admission. His fever resolved within the day, followed by a rapid improvement in his general condition and laboratory findings. His rash improved simultaneously, although his skin discoloration remained. On hospital day 18, he was discharged. At a 3-month follow-up, he remained well with the prednisolone treatment, which was stopped after 3 months. Later, it was confirmed that his aortitis, lung injury, splenomegaly and neutrophilic eccrine hidradenitis were associated with pegfilgrastim. Additionally, it was noted that doxorubicin and ifosomide were also contributed in neutrophilic eccrine hidradenitis. Kametani T, et al. Granulocyte Colony-Stimulating Factor-Induced Aortitis with Lung Injury, Splenomegaly, and a Rash During Treatment for Recurrent Extra