Osamu NAKAI, Shinsaku IMASHUKU
Rheumatology Quarterly - 2026;4(2):133-136
The differential diagnosis of large vessel vasculitis (LVV) in patients with cancer is often challenging. We describe a 56-year-old woman with a long-standing history of recurrent breast carcinoma who developed LVV detected on [18F] FDG-PET/CT. Over 18 years, she underwent multiple treatments for cancer, including initial surgery with adjuvant oral cyclophosphamide and UFT for 3 years, surgery for liver metastasis followed by palbociclib, and surgery for bilateral ovarian metastases without subsequent chemotherapy, followed by monthly intramuscular fulvestrant. Notably, she had never received granulocyte colony-stimulating factor (G-CSF). Based on clinical and imaging findings, the LVV was diagnosed as Takayasu arteritis (TAK). Treatment with weekly or biweekly subcutaneous tocilizumab (TCZ) combined with low-dose prednisolone was initiated, during which peripheral eosinophilia developed. This case underscores the diagnostic complexity of LVV in patients with cancer and highlights a potential association between TCZ therapy and eosinophilia.
