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Cherri S, Prochilo T, Rota L, Mutti S, Garatti M, Liserre B, Zaniboni A. Neutropenic Enterocolitis in the Treatment of Solid Tumors: A Case Report and Review of the Literature. Case Rep Oncol 2020; 13:442-448. [PMID: 32399014 PMCID: PMC7204860 DOI: 10.1159/000506896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Neutropenic enterocolitis is a clinical condition characterized by inflammation of the colic mucosa, usually the caecum, associated with bowel wall thickening in patients with compromised immune system due to chemotherapy treatments. It can occur as well in other clinical conditions that lead to immunosuppression. Clinically, patients present with abdominal pain, fever, and neutropenia on blood tests. A number of major and minor criteria have been suggested for the clinical diagnosis of typhlitis. The most sensitive radiological investigation is represented by a computed tomography scan. There are no guidelines for treatment, but some factors may lead the clinician to medical treatments or prompt surgery as the best choice in that particular patient. The most implicated chemotherapeutic regimens are those based on taxanes. Here, we present a clinical case of a young patient with breast cancer and a review of the state of the art of knowledge regarding neutropenic enterocolitis in adult patients undergoing chemotherapy for the treatment of solid tumors.
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Affiliation(s)
- Sara Cherri
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Tiziana Prochilo
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Luigina Rota
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Stefano Mutti
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Barbara Liserre
- Department of Pathology, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
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Abstract
The paper describes the case of a 69-year-old man with non-small-cell lung cancer who, owing to a mistake, received intravenously 500 mg of vinorelbine. Within 3 days of intoxication, the bone marrow of the patient was damaged with subsequent pancytopenia that did not respond to treatment. On the fifth day after the poisoning, features of intestinal obstruction appeared. The patient died on the sixth day after the drug overdose. The case presented by us constitutes the first description of a fatal iatrogenic poisoning with this drug.
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Schmidt-Hieber M, Bierwirth J, Buchheidt D, Cornely OA, Hentrich M, Maschmeyer G, Schalk E, Vehreschild JJ, Vehreschild MJGT. Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2017; 97:31-49. [PMID: 29177551 PMCID: PMC5748412 DOI: 10.1007/s00277-017-3183-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/11/2017] [Indexed: 12/15/2022]
Abstract
Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.
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Affiliation(s)
- M Schmidt-Hieber
- Clinic for Hematology, Oncology, Tumor Immunology and Palliative Care, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - J Bierwirth
- Deutsches Beratungszentrum für Hygiene, BZH GmbH, Freiburg, Germany
| | - D Buchheidt
- 3rd Department of Internal Medicine - Hematology and Oncology - Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany
| | - O A Cornely
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany
| | - M Hentrich
- Department III for Internal Medicine, Hematology and Oncology, Rotkreuzklinikum München, Munich, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany
| | - E Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - J J Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany. .,German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany. .,1st Department of Internal Medicine, Hospital of the University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
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Moris DN, Spartalis E, Perdiki M, Michailides K, Felekouras E, Papalampros A. Opening Aeolus' Bag of Winds: Acute Abdominal Pain in a Severely Immunosuppressed Patient. J Emerg Med 2016; 51:e29-32. [PMID: 27156492 DOI: 10.1016/j.jemermed.2015.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/08/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NE) is a necrotizing disease mostly of the ileocecal region. It is a severe and potentially life-threatening complication that can affect patients undergoing chemotherapy for lymphoma. We analyze a case of NE that occurred in a patient with non-Hodgkin's lymphoma during chemotherapy with concurrent HIV infection. CASE REPORT We present a case of a 37-year-old woman who was admitted to our emergency department because of acute abdominal pain. Her medical history included HIV infection and B-cell immunoblastic lymphoma. For the latter, the patient was receiving rituximab cyclophosphamide hydroxydaunorubicin oncovin vincristine prednisone (R-CHOP) regimen. A complete blood count showed a low leukocyte count (40/mm³) and a low neutrophil count (32/mm³). An exploratory laparotomy with midline incision was performed. Intraoperatively, the cecum and the proximal part of the ascending colon were found to be edematous with the mesocolon being extremely gelatinous without macroscopically identified ischemia. Histopathology revealed a nonspecific infarction necrosis of the bowel wall with multiple ulcerations in the cecum, but no evidence of major vessel thrombosis. The patient had an uneventful postoperative course and was discharged in good condition on the 10th postoperative day. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is the first reported case of NE in a patient with acquired immune-deficiency syndrome who developed the syndrome during an episode of severe neutropenia and was treated surgically. The decision to operate should be balanced between the clinical and laboratory status as well as the operative risk. Physicians should be aware of this complication of chemotherapy, especially in severely immunosuppressed patients, because it could be triggered just by an episode of neutropenia.
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Affiliation(s)
- Demetrios N Moris
- First Department of Surgery, Vascular Unit, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- First Department of Surgery, Vascular Unit, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Perdiki
- Division of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Felekouras
- First Department of Surgery, Vascular Unit, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Papalampros
- First Department of Surgery, Vascular Unit, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Vehreschild MJGT, Vehreschild JJ, Hübel K, Hentrich M, Schmidt-Hieber M, Christopeit M, Maschmeyer G, Schalk E, Cornely OA, Neumann S. Diagnosis and management of gastrointestinal complications in adult cancer patients: evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Oncol 2013; 24:1189-202. [PMID: 23401037 DOI: 10.1093/annonc/mdt001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer patients frequently suffer from gastrointestinal complications. However, a comprehensive, practical and evidence-based guideline on this issue is not yet available. PATIENTS AND METHODS An expert group was put together by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) to develop a guideline on gastrointestinal complications in cancer patients. For each subtopic, a literature search was carried out in PubMed, Medline and Cochrane databases and the strength of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using a modification of the 'Infectious Diseases Society of America' criteria. Consensus discussions were held on each of the topics. RESULTS Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. For all recommendations, the strength of the recommendation and the level of evidence are presented. CONCLUSION This guideline is an evidence-based approach to the diagnosis and management of gastrointestinal complications in cancer patients.
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Abstract
Neutropenic enterocolitis or typhlitis (from the Greek word typhlon, meaning cecum) is a clinical syndrome that occurs in the setting of disease or chemotherapy-induced neutropenia. The disease is characterized by an inflammatory process involving colon and/or small bowel, and it can result in ischemia, necrosis, bacteremia, hemorrhage, and perforation. The classic clinical features include fever and abdominal pain. The diagnosis is supported by the findings of bowel wall thickening on ultrasonography or CT imaging. The management of neutropenic enterocolitis is controversial. Neither prospective nor high-quality retrospective studies concerning medical or surgical therapies are available. Most authors will recommend initial conservative management with bowel rest, intravenous fluids, total parenteral nutrition, broad-spectrum antibiotics and normalization of neutrophil counts. Surgical intervention is recommended in the setting of obstruction, perforation, persistent gastrointestinal bleeding despite correction of thrombocytopenia and coagulopathy, and clinical deterioration.
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Affiliation(s)
- Marta L Davila
- Department of Gastrointestinal Medicine and Nutrition, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 436, Houston, TX 77030-4009, USA.
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Ullery BW, Pieracci FM, Rodney JRM, Barie PS. Neutropenic enterocolitis. Surg Infect (Larchmt) 2009; 10:307-14. [PMID: 19566419 DOI: 10.1089/sur.2008.061] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Neutropenic enterocolitis, sometimes called typhilitis, is the most common gastrointestinal infection related to neutropenia, but its rarity, confusing terminology, and protean, non-specific manifestations result in variable approaches to diagnosis and management. METHODS Review of pertinent English-language literature. RESULTS The true incidence of neutropenic enterocolitis is unknown, but may be 5% or more among adult patients receiving chemotherapy for solid malignant tumors. The incidence is reported to be slightly lower in children. Estimates are made complex by recent recognition that neutropenia of any cause may be associated with enterocolitis; reports of non-chemotherapy drug-associated cases are increasing. Mortality rates are reported currently to be between 30% to 50%. The exact pathogenesis is also unknown, and may contribute to the varied nomenclature in use. Gut mucosal ulcerations may result from direct drug-related cytotoxicity, or from neutropenia itself. Microbial invasion of the bowel wall proceeds unimpeded. Pathological changes include inflammation and edema, presumably followed by ulceration, transmural necrosis, and perforation. The classic clinical presentation consists of fever, abdominal pain, and neutropenia, but diagnosis is often hindered by subtle or non-specific clinical findings, making computed tomography the linchpin of diagnosis. The wide spectrum of clinical presentation requires an individualized approach to therapy. Medical management, including administration of granulocyte colony-stimulating factor, may be appropriate for patients who do not have gastrointestinal bleeding, peritonitis, or intestinal perforation. Surgical management is generally reserved for patients who fall into any of the exceptional categories, and consists usually of bowel resection and stoma creation. CONCLUSIONS Neutropenic enterocolitis is a heterogeneous diseazse state with the capacity to affect many areas of the gastrointestinal tract, and disease severity that ranges from mild to fatal. A high index of suspicion is needed for all patients who present with fever and abdominal pain in the setting of neutropenia. Early detection allows a majority of cases to resolve with nonoperative management and supportive care, but surgical intervention is mandatory for peritonitis, bowel perforation, or gastyrointestinal hemorrhage that persists despite correction of coagulopathy.
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Affiliation(s)
- Brant W Ullery
- Department of Surgery, Weill Cornell Medical College, New York, New York 10021, USA
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Cherny NI. Evaluation and management of treatment-related diarrhea in patients with advanced cancer: a review. J Pain Symptom Manage 2008; 36:413-23. [PMID: 18411014 DOI: 10.1016/j.jpainsymman.2007.10.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 10/17/2007] [Accepted: 10/31/2007] [Indexed: 01/27/2023]
Abstract
Diarrhea is a common and significant problem among patients with advanced cancer. Treatment-induced diarrhea can be severe and be associated with life-threatening dehydration and electrolyte abnormalities. The causes of diarrhea among patients with advanced cancer are diverse and some causes of diarrhea require specific therapies. Thus, careful evaluation of the underlying cause is necessary. Palliative care clinicians, particularly those dealing with patients receiving ongoing disease-modifying therapies, must be familiar with the common causes of diarrhea among cancer patients and the strategies to evaluate and manage these common and distressing symptoms. This article addresses four major issues: 1) a review of the causes of treatment-related diarrhea, focusing on diarrhea caused by chemotherapy, targeted therapies, and radiotherapy; 2) differential diagnosis and an approach to evaluation; 3) general management considerations; and 4) cause-specific issues in management.
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Affiliation(s)
- Nathan I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Aksoy DY, Tanriover MD, Uzun O, Zarakolu P, Ercis S, Ergüven S, Oto A, Kerimoglu U, Hayran M, Abbasoglu O. Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis. Ann Oncol 2006; 18:183-189. [PMID: 17023562 DOI: 10.1093/annonc/mdl337] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although diarrhea is a frequent complication in neutropenic patients, its true incidence, risk factors and clinical course have not been investigated prospectively. PATIENTS AND METHODS The study was carried out at Hacettepe University Hospital for Adults and involved patients over 16 years of age. Patients with malignant diseases who were neutropenic on admission or who became neutropenic during their stay in the wards between January 2001 and February 2003 were included. They were monitored daily until discharge, exitus, or recovery from neutropenia-whichever occurred earlier-to monitor the presence of diarrhea and other infections. RESULTS A total of 317 neutropenic episodes in 215 patients were followed. Diarrhea was observed in 18.6% episodes, and the incidence of NEC was 3.5%. The etiology in 27% episodes of diarrhea could not be identified. The use of anthracyclines and mitoxantrone increased the incidence of diarrhea. Prior use of penicillin derivatives plus beta-lactam inhibitors and N-imidazoline derivatives was associated with decreased incidence of diarrhea. CONCLUSIONS Diarrhea is a common complication in neutropenic patients. Not only specific conditions like NEC, but also nonspecific diseases like parasitosis may be the cause of diarrhea in this patient population.
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Affiliation(s)
| | | | - O Uzun
- Section of Infectious Diseases, Department of Medicine
| | - P Zarakolu
- Section of Infectious Diseases, Department of Medicine
| | - S Ercis
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara 06100, Turkey
| | - S Ergüven
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara 06100, Turkey
| | - A Oto
- Department of Radiology, University of Texas, Medical Branch at Galveston, Galveston, Texas
| | | | - M Hayran
- Department of Preventive Oncology, Institute of Oncology
| | - O Abbasoglu
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara 06100, Turkey
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Bremer CT, Monahan BP. Necrotizing enterocolitis in neutropenia and chemotherapy: a clinical update and old lessons relearned. Curr Gastroenterol Rep 2006; 8:333-41. [PMID: 16836946 DOI: 10.1007/s11894-006-0055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Neutropenic enterocolitis (NE) must be recognized in patients with fever, neutropenia, and abdominal pain. Classically, NE has been described in patients with hematologic malignancies treated with intensive chemotherapy. Current interest in NE has increased due to recent cases associated with newer, more intensive chemotherapy in solid tumors. This review discusses pathology, clinical presentation, and treatment of NE. Ultrasonography or CT scans are the best radiographic studies to confirm the diagnosis. Management options, including antimicrobial therapy, surgery, and supportive care, are discussed. Chemotherapy incorporating the taxane family of drugs (paclitaxel and docetaxel) associated with NE is also reviewed with observations regarding the earlier onset of the disease in the first weeks following chemotherapy. Even with currently recommended therapy, a high mortality rate, approximating 45%, can occur. Best outcomes for NE rely upon understanding of risks for the condition, prompt empiric therapy with broad-spectrum antimicrobial agents, systemic antifungal therapy, and meticulous attention to supportive care.
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Affiliation(s)
- CelesteAnn T Bremer
- Division of Hematology, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4217, USA
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Cardona Zorrilla AF, Reveiz Herault L, Casasbuenas A, Aponte DM, Ramos PL. Systematic review of case reports concerning adults suffering from neutropenic enterocolitis. Clin Transl Oncol 2006; 8:31-8. [PMID: 16632437 DOI: 10.1007/s12094-006-0092-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Neutropenic enterocolitis (NEC) is a well recognised clinical-pathological and life-threatening complication in patients suffering from several conditions, including solid and haematological malignancies or aplastic anaemia. OBJECTIVE This review was aimed at evaluating overall NEC mortality rate, describing clinical diagnostic findings and therapeutical interventions reported in the literature and generating a hypothesis regarding factors influencing mortality and surgical intervention. MATERIALS AND METHODS An advanced search was made in Medline, Embase, Lilacs and Google. Additional strategies included manual search of specific journals. Reports were considered if they described case definition, inclusion and exclusion criteria. RESULTS 275 cases were selected; 109 were from individual data and 40 from grouped data. Comparing data between case reports and case series revealed no significant differences related to mortality, surgical intervention, sex or age. Higher mortality (chi2 = 7.51 p = 0.006) was found in women (50%) compared to men (28%). No significant difference was found between antibiotic combinations and mortality (chi(2) = 12.85 df 13 p = 0.45). Mortality (chi2 = 3.89 df 1, p = 0.049), surgical intervention (chi2 = 7.64 df 1, p = 0.006) and duration of diarrhoea (chi2 = 4.71 df 1, p = 0.043) were significantly different in 26.4% of individuals using antifungal agents; death occurred in 81% of patients! who did not receive such medication compared to 19% individuals reported as being treated with antifungal agents. CONCLUSION The current evidence suggests that antifungal agents should be used early in patients suffering from NEC. However, this hypothesis must be evaluated in multi-centric, randomised controlled trials.
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Takaoka EI, Kawai K, Ando S, Shimazui T, Akaza H. Neutropenic colitis during standard dose combination chemotherapy with nedaplatin and irinotecan for testicular cancer. Jpn J Clin Oncol 2006; 36:60-3. [PMID: 16436462 DOI: 10.1093/jjco/hyi219] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 54-year-old man received combination chemotherapy with nedaplatin and irinotecan as salvage chemotherapy for refractory non-seminomatous testicular cancer. The patient developed abdominal pain and high fever on Day 21 after the initiation of chemotherapy. Computed tomography revealed thickening of the terminal ileum wall and paralytic ileus. The patient recovered with intensive supportive management including broad-spectrum antibiotics, bowel rest with gastric intubation and intravenous gamma-globulin. Neutropenic colitis has been thought to be a serious gastrointestinal complication associated with chemotherapy for hematological malignancy. The mortality rate is as high as 21-48% according to a recent review. The present case indicates that the neutropenic colitis can occur under neutropenic conditions induced by the standard-dose chemotherapy for solid cancer.
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Affiliation(s)
- Ei-Ichiro Takaoka
- Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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Abstract
PURPOSE OF REVIEW This review will cover the recent literature pertaining to the pathogenesis, diagnosis, and management of patients with neutropenic enterocolitis. RECENT FINDINGS Neutropenic enterocolitis, also referred to as typhlitis, is a life-threatening gastrointestinal complication of chemotherapy, most often associated with leukemia or lymphoma. Recently, a larger number of reports have been published of individuals presenting with this syndrome after being treated with newer chemotherapeutic agents for solid tumors such as non-small cell lung, ovarian, and peritoneal cancer, as well as following autologous stem cell transplantation. Recent studies have also better characterized computed tomographic and ultrasonographic features of this entity that can help differentiate neutropenic enterocolitis from other gastrointestinal complications. A newly published systematic analysis of the literature, which included 145 articles, defines appropriate diagnostic criteria and treatment recommendations. SUMMARY Neutropenic enterocolitis is a serious, potentially lethal complication of anticancer therapy. The studies discussed in this review will help the practitioner make an appropriate, early diagnosis and implement a therapeutic program that would improve the outcome of these patients.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Enterocolitis, Neutropenic/chemically induced
- Enterocolitis, Neutropenic/diagnosis
- Enterocolitis, Neutropenic/epidemiology
- Enterocolitis, Neutropenic/therapy
- Female
- Humans
- Incidence
- Intestinal Mucosa/pathology
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/drug therapy
- Male
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Survival Rate
- Tomography, X-Ray Computed
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Affiliation(s)
- Marta L Davila
- Department of Gastrointestinal Medicine and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA.
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Gorschlüter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IGH, Sauerbruch T, Glasmacher A. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 2005; 75:1-13. [PMID: 15946304 DOI: 10.1111/j.1600-0609.2005.00442.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Neutropenic enterocolitis is a life-threatening complication occurring most frequently after intensive chemotherapy in acute leukaemias. The literature is heterogeneous and a systematic review is lacking. METHODS Following a systematic search we categorised all relevant reports according to their quality and extracted evidence to answer the questions: Which diagnostic criteria are appropriate? What is the incidence of neutropenic enterocolitis? Are there good quality studies supporting specific interventions: Which empiric antimicrobial therapy is recommendable? Is neutropenic enterocolitis without surgical emergency complications an indication for bowel resection? RESULTS We found and analysed 145 articles of these reports: 64 were reports of single cases, 30 papers reported of two or three cases, 13 were narrative reviews, 34 were retrospective case series of more than three cases and four were prospective diagnostic studies. There were no prospective trials or case control studies on the therapy of neutropenic enterocolitis. There was no consensus on diagnostic criteria. We discuss the difficulty to define diagnostic criteria without having a disease definition. Histology is mostly not available in the living patients. We suggest applying a combination of clinical and radiological criteria: fever, abdominal pain and any bowel wall thickening >4 mm detected by ultrasonography (US) or computed tomography. We calculated a pooled incidence rate from 21 studies of 5.3% (266/5058; 95% CI: 4.7%-5.9%) in patients hospitalised for haematological malignancies, for high-dose chemotherapy in solid tumours or for aplastic anaemia. CONCLUSIONS This systematic review provides diagnostic criteria for neutropenic enterocolitis, presents a quantitative synthesis on its incidence and discusses its treatment recommendations. Prospective studies are clearly warranted.
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Affiliation(s)
- Marcus Gorschlüter
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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Furonaka M, Miyazaki M, Nakajima M, Hirata S, Fujitaka K, Kondo K, Yokoyama A, Maeda H, Kohno N. Neutropenic enterocolitis in lung cancer: a report of two cases and a review of the literature. Intern Med 2005; 44:467-70. [PMID: 15942096 DOI: 10.2169/internalmedicine.44.467] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The first patient, a 68-year-old woman, presented neutropenic fever and hemorrhagic diarrhea on the sixth day of a combination chemotherapy of carboplatin and paclitaxel. The second patient, a 30-year-old man, presented neutropenia and diarrhea on the tenth day of the second cycle of a combination chemotherapy of cisplatin and vinorelbine. In both patients, abdominal computed tomography scan showed thickening of the colon wall and pericolic edema, and the ultrasonography revealed echogenic thickening of the colon walls. These findings confirmed the diagnosis of neutropenic enterocolitis. After the treatments, we changed the anticancer drug regimen; and successfully achieved partial responses.
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Affiliation(s)
- Makoto Furonaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Japan
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Cunningham SC, Fakhry K, Bass BL, Napolitano LM. Neutropenic enterocolitis in adults: case series and review of the literature. Dig Dis Sci 2005; 50:215-20. [PMID: 15745075 DOI: 10.1007/s10620-005-1585-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Necrotizing enterocolitis in adults is a rare disease and, in the past, has been associated with nearly uniform mortality. In recent years, necrotizing enterocolitis, now termed neutropenic enterocolitis, in adults has become more prevalent as a complication of aggressive systemic chemotherapy. In this report, we discuss two cases of neutropenic enterocolitis secondary to the administration of systemic chemotherapy in adult cancer patients: one with lung carcinoma, the other with leukemia. Both patients were successfully treated with early surgical intervention for resection of all necrotizing enteric lesions, and subsequent aggressive critical care support. Our experience suggests that early surgical intervention in adult patients with intestinal necrosis due to chemotherapy is essential to avoid mortality from this condition. Given the widespread, aggressive use of systemic chemotherapy in the neoadjuvant setting, patients at risk for this potentially lethal complication of neutropenic enterocolitis are increasingly common.
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Affiliation(s)
- Steven C Cunningham
- Department of Surgery, Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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van de Wetering MD, Kuijpers TW, Taminiau JAJM, ten Kate FJW, Caron HN. Pseudomembranous and neutropenic enterocolitis in pediatric oncology patients. Support Care Cancer 2003; 11:581-6. [PMID: 12768402 DOI: 10.1007/s00520-003-0483-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 04/08/2003] [Indexed: 02/06/2023]
Abstract
Neutropenic enterocolitis in oncological patients represents a wide spectrum of clinicopathological pictures each with its own entity. Early diagnosis of enterocolitis can lead to improved supportive care and therefore better outcome. We present two cases--patient A, a child with pseudomembranous colitis caused by Clostridium difficile, and patient B, a child with neutropenic enterocolitis, where no organism was found. By allowing an insight into the pathology, immunology and culture results, we demonstrated that early diagnosis leads to improved management and therefore improved outcome.
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Affiliation(s)
- M D van de Wetering
- Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands.
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Abstract
Neutropenic enterocolitis is an acute syndrome characterized by cecal and ascending colon inflammation that may progress to necrosis and perforation. It is most often associated with leukemia but has also been described in patients with solid tumors, multiple myeloma, aplastic anemia, AIDS, and cyclic neutropenia. Medical management usually suffices, but surgical intervention may be required.
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Affiliation(s)
- Mary F Bavaro
- Department of Infectious Disease, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
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