Neutropenic enterocolitis
From IDWiki
Background
- Inflammation of right-sided colon in the context of febrile neutropenia
Microbiology
- Includes gut anaerobes
Clinical Manifestations
- Fever, abdominal pain, diarrhea, and right lower quadrant tenderness with or without peritonitis in the context of febrile neutropenia
- May mimic appendicitis
- Mortality of up to 20%
Differential Diagnosis
- Clostridioides difficile diarrhea
- Colonic ischemia
- CMV colitis
- Mycophenolate-induced colitis
Investigations
- CT shows bowel wall thickening >4 mm
- Colonoscopy is relatively contraindicated
Management
- Bowel rest with TPN
- Broad-spectrum antibiotics
- Consider empiric ganciclovir and oral vancomycin with IV metronidazole, wile awaiting CMV and Clostridioides difficile results
