Neutropenic Enterocolitis: Case report and literature review

Area of Science:

• Gastroenterology
• Oncology
• Internal Medicine

Background:

• Typhlitis, also known as neutropenic enterocolitis, is an inflammation primarily affecting the cecum and distal ileum.
• While frequently observed in pediatric leukemia patients undergoing chemotherapy, it can occur in adults with any cause of immunosuppression.

Approach:

• This report details a case of a 20-year-old osteosarcoma patient undergoing chemotherapy who presented with severe gastrointestinal symptoms and neutropenia.
• Diagnostic evaluation included physical examination, laboratory workup revealing neutropenia and thrombocytopenia, and imaging studies showing colonic edema.

Key Points:

• The patient exhibited hemodynamic instability, abdominal pain, nausea, vomiting, and diarrhea.
• Initial treatment involved supportive care, transfusions, G-CSF, hydration, and broad-spectrum antibiotics, with an initial positive response.
• The patient later developed lower gastrointestinal bleeding, managed conservatively.

Conclusions:

• Typhlitis should be suspected in any patient with neutropenia secondary to chemotherapy who develops gastrointestinal symptoms.
• Prompt recognition and management are essential for improving patient outcomes.