Reactions 801 - 13 May 2000

SAntineoplastics

Typhlitis: 3 case reportsThree women, aged 33, 42 and 57 years, developed typhlitis

while undergoing antineoplastic therapy with autologousblood stem cell transplantation for the treatment of metastaticbreast cancer. The two younger women subsequently died.

All three women had received a variety of antineoplastics forthe treatment of breast cancer, including doxorubicin,cyclophosphamide, carboplatin, thiotepa, methotrexate,fluorouracil, tamoxifen and paclitaxel [dosage and duration oftherapies not stated]. They each received milodistim,granulocyte-macrophage colony-stimulating factor orgranulocyte colony-stimulating factor therapy for neutropeniaprophylaxis.

Following treatment with antineoplastic agents, all thewomen developed severe diarrhoea, neutropenia and fever(38.3–38.5°C). In each case, the symptoms presented a fewdays after the infusion of peripheral blood progenitor cells.Physical examinations and CT scans revealed all or some of thefollowing signs and symptoms in each woman: increased ordecreased bowel sounds, abdominal tenderness, guarding andabdominal distension. They all developed infections asdetermined by stool or blood analyses, which were treatedwith anti-infectives.

The 33-year-old woman had thickening of the wall of hersmall bowel. She subsequently developed functionalgastrointestinal (GI) obstruction and required a nasogastrictube. She received a back-up bone marrow harvest due tocontinuing neutropenia. Her abdominal pain graduallyresolved, but her absolute neutrophil count remained low(500/µl). Her fever then resolved, her GI symptoms improvedand there was no evidence of pathogenic infection. However,she subsequently developed bradycardia with respiratoryarrest and ventricular fibrillation and she died. Autopsyrevealed mucosal hyperaemia at the ileocaecal valve, cardiacbiventricular hypertrophy, pulmonary oedema andmicroscopic autolysis of her intestinal mucosa.

The 42-year-old woman had a thickened small bowel wallwith oedema and a fluid-filled dilated caecum and colon. A fewdays after her treatment started, her absolute neutrophil countwas 1080/µl. She developed severe abdominal distensionrequiring a nasogastric tube and hypotension requiringpressors. She subsequently required intubation. The next day,bilateral pleural effusions and ascitic fluid were aspirated. Herabsolute neutrophil count was elevated (7200/µl) and her feverand diarrhoea persisted. An abdominal examination revealedonly distension at this stage, however, supportive measureswere ineffective and she died. Autopsy revealed the presenceof 4 bacterial pathogens in her blood, diffuse transmuralhaemorrhage, necrosis of small and large intestines, a patchyfibropurulent exudate in her small intestine, and microscopicmucosal and submucosal oedema and haemorrhage of hersmall and large intestines. There was also diffuse and intenseneutrophilic polymorphonuclear fibropurulent exudate of themucosa with bacterial colonies, focal mucosal necrosis andfocal fibropurulent serositis of the large intestine.

The 57-year-old woman developed massive colon wallthickening with fat stranding and dilated loops of her bowel.She subsequently developed bloody stools, although herabsolute neutrophil count increased. Over the next few days,her abdominal pain improved, her fever resolved and her rectalbleeding stopped. A flexible sigmoidoscopy revealedsubmucosal oedema with no evidence of infection. Shecontinued to improve and was discharged approximately 1month after admission.Boggio L, et al. Typhlitis complicating autologous blood stem cell transplantationfor breast cancer. Bone Marrow Transplantation 25: 321-326, No. 3, Feb 2000 -USA 800824883

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Reactions 13 May 2000 No. 8010114-9954/10/0801-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved