Q: 34 year old oncology patient on active chemotherapy cycles admitted to ICU with neutropenic fever and sepsis. Patient is started on broad spectrum antibiotics and "Sepsis protocol". Oncology service also added filgrastim. While a week later in ICU as patient was getting ready to get transfer out of ICU, c/o severe LUQ pain radiating to shoulder. What is your concern? 



Answer: Splenic rupture 

Granulocyte colony stimulating factors (G-CSF) are frequently used in patients s/p chemotherapy to avoid complications of neutropenia. One of the rare but catastrophic complication of G-CSF is splenic rupture. Cardiovascular and neurologic events, and splenic rupture are known side effects of high dose G-CSF therapy. Most of the reported cases are either healthy donors of stem cell transplant patients or patients undergoing peripheral blood stem cell mobilization for transplant (PBSCT). But it is also reported and should be watched for patients on active chemotherapy with neutropenia. Splenic rupture is thought to be due to extramedullary myelopoies leading to parenchymal congestion.