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Acute appendicitis in adult neutropenic patients with hematologic malignancies

Bone Marrow Transplantation volume 42, pages 701–703 (2008)Cite this article

Abdominal complications occur frequently in immunocompromised hematologic patients under chemotherapy, especially at high doses. It has been estimated that 30% of infectious complications arise from the gastrointestinal tract, and the diagnostic and therapeutic management of acute surgical abdomen in this clinical setting still remains a dilemma.1 We report here on two adult patients with hematologic malignancy who developed acute appendicitis under chemotherapy.

Patient 1, a 68-year-old woman affected with multiple myeloma IgG-k, previously treated with thalidomide/dexamethasone, was admitted to our department to receive high-dose melphalan therapy (200 mg/m2 on day −2) supported by autologous PBSC infusion (previously collected) with G-CSF until neutrophil recovery. On the day of PBSC infusion (day 0), the patient presented with vomiting, diarrhea and diffuse abdominal pain without fever. Abdominal examination revealed rebound tenderness, especially over McBurney's point. Plain abdominal radiography showed dilated bowel loops and multiple air–fluid levels, whereas ultrasonography was negative. Because of the persistence of symptoms after 48 h and the appearance of low-grade fever (temperature 37.5 °C), an urgent abdominal computed tomography (CT) was performed. Wall thickening of the appendix and fat stranding were found, suggestive of acute appendicitis, and so the patient underwent urgent appendectomy after platelet support, because the platelet count was 62 × 109/l. Furthermore, broad-spectrum antibiotic treatment, initially with piperacillin–tazobactam and metronidazole and then with meropenem, teicoplanine and metronidazole, was introduced because of low WBC count (3.4 × 109/l), even though serological, cultural and molecular examinations on biologic fluids were negative. The surgical procedure, which began laparoscopically, revealed an acutely inflamed gangrenous appendix that required the conversion to an open procedure (minilaparotomy). The day after the intervention, WBC count was 0.2 × 109/l, and recovery of the neutrophil count was achieved on day +9. Neither acute nor late abdominal complications occurred.

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Acknowledgements

We are indebted to the nurse staff of the Department of Oncology and Hematology, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy, for the careful management of the patients.

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Authors and Affiliations

  1. Department of Oncology and Hematology, Section of Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Modena, Italy

    F Forghieri, M Luppi, F Narni, M Morselli, L Potenza, P Bresciani, F Volzone, P Barozzi & G Torelli

  2. Department of Pathology, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Modena, Italy

    G Rossi

  3. Department of Surgery, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Modena, Italy

    A Rossi & L Trenti

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  1. F Forghieri
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Correspondence to M Luppi.

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Forghieri, F., Luppi, M., Narni, F. et al. Acute appendicitis in adult neutropenic patients with hematologic malignancies. Bone Marrow Transplant 42, 701–703 (2008). https://doi.org/10.1038/bmt.2008.235

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