Severe ARDS Secondary to Filgrastim Administration, Successfully Treated With VV ECMO

Introduction: Filgrastim, a drug commonly used to stimulate neutrophil production, is generally safe. However, in rare instances, it can cause severe complications like Acute Respiratory Distress Syndrome (ARDS). This case study presents an unusual situation where a previously healthy donor developed severe ARDS after receiving Filgrastim, a reaction so critical it required VV ECMO


Description: An 18-year-old male, serving as a donor of hematopoietic progenitor cells for his father, was given four doses of Filgrastim over six days. Shortly after, he experienced sudden respiratory distress, dry cough, and rapid clinical deterioration. He was transferred to a tertiary care center where he was diagnosed with severe hypoxemic respiratory failure, requiring mechanical ventilation.Due to his condition worsening, he was placed on peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO). He also developed multi-organ failure, requiring support for his blood pressure and kidneys. Over the following days, his lung function and gas exchange improved. He was successfully weaned off mechanical ventilation, and eventually, off ECMO, along with the other organ support therapies.


Discussion: Filgrastim, a cornerstone in hematology, can cause adverse reactions. In this case, the ARDS likely developed due to an exaggerated immune response. Filgrastim stimulates neutrophils, which, in the presence of an infection, can release inflammatory mediators into the lungs. This leads to microvascular injury, fluid accumulation, and ultimately, severe lung damage characteristic of ARDS.

The use of VV ECMO was crucial and successful in this case. The patient's condition, with persistent hypoxemia despite optimal ventilation, met the clinical criteria for ECMO initiation. This case is particularly significant because it’s the first recorded instance of a healthy Filgrastim donor with ARDS who required and successfully recovered with ECMO support. It highlights the importance of using advanced supportive therapies like ECMO in rare, life-threatening complications.