Neutropenic enterocolitis: Difference between revisions
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* Inflammation of right-sided colon in the context of febrile neutropenia |
* Inflammation of right-sided colon in the context of febrile neutropenia |
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=== Microbiology === |
=== Microbiology === |
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* Includes gut [[anaerobes]] |
* Includes gut [[anaerobes]] |
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== Clinical Manifestations == |
== Clinical Manifestations == |
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| − | * Fever, abdominal pain, and right lower quadrant tenderness with or without peritonitis in the context of [[febrile neutropenia]] |
+ | * Fever, abdominal pain, diarrhea, and right lower quadrant tenderness with or without peritonitis in the context of [[febrile neutropenia]] |
* May mimic [[appendicitis]] |
* May mimic [[appendicitis]] |
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| + | * Mortality of up to 20% |
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| + | == Differential Diagnosis == |
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| + | * [[Clostridioides difficile]] diarrhea |
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| + | * Colonic ischemia |
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| + | * [[CMV]] colitis |
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| + | * [[Mycophenolate]]-induced colitis |
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| + | == Investigations == |
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| + | * CT shows bowel wall thickening >4 mm |
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| + | * Colonoscopy is relatively contraindicated |
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| + | == Management == |
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| + | * Bowel rest with [[TPN]] |
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| + | * Broad-spectrum antibiotics |
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| + | * Consider empiric [[ganciclovir]] and oral [[vancomycin]] with IV [[metronidazole]], wile awaiting [[CMV]] and [[Clostridioides difficile]] results |
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[[Category:Immunocompromised hosts]] |
[[Category:Immunocompromised hosts]] |
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Latest revision as of 21:20, 3 October 2022
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
