A 27-year-old female presented with a known case of triple-negative breast cancer, complaining of documented fever of 40°C at home, which was relieved with an antipyretic. She was on the status of post-4 cycles of neoadjuvant dose-dense AC regimen, which comprised doxorubicin 60 mg/m 2 and cyclophosphamide 600 mg/m 2 administered every 14 days. She was prescribed primary prophylaxis with filgrastim after all cycles.
The patient was admitted to the hospital with febrile neutropenia with no focus of infection and was on empiric antibiotics and filgrastim. She had a low WBC count with an absolute neutrophil count of 1100 cells/µL on day 11 after cycle 4, despite being on an appropriate filgrastim dose of 300 μg per day for nine days. On the second day of her admission, she recovered from neutropenia but continued to have a persistent high-grade fever for almost two weeks, despite an…
