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Phlegmonous duodenitis complicating multiple myeloma: a successfully treated case.
P D Kneafsey1, J K Kelly, D L Church
1Department of Pathology, University of Calgary, Foothills Hospital, Alberta, Canada.
The American Journal of Gastroenterology
|December 1, 1987
Summary
Immunosuppressed patients with acute abdomen may have localized suppurative intestinal infection. Prompt surgical intervention and antibiotics are crucial for recovery, as seen in this multiple myeloma case.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Oncology
Background:
- Multiple myeloma patients undergoing chemotherapy are often immunosuppressed, increasing susceptibility to infections.
- Acute abdomen presentation in these patients requires careful differential diagnosis to identify serious underlying conditions.
Observation:
- A patient with multiple myeloma presented with acute abdomen, fever, and elevated neutrophils during chemotherapy.
- Laparotomy revealed a swollen, hemorrhagic distal duodenum, necessitating surgical excision.
- Histological examination showed acute phlegmonous duodenitis with severe inflammation, despite intact mucosa.
Findings:
- Blood cultures identified Group B beta-hemolytic streptococci.
- Gram-positive cocci were also identified histologically.
- The patient recovered after surgery and broad-spectrum antibiotics.
Implications:
- Localized suppurative intestinal infection is a critical consideration for immunosuppressed patients with acute abdominal symptoms.
- Aggressive surgical management combined with appropriate antibiotic therapy can lead to favorable outcomes.
- This case highlights the importance of considering unusual infections in immunocompromised individuals presenting with abdominal emergencies.