DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20222542
Published: 2022-09-27

Neutropenic enterocolitis in a non-immunocompromised patient presenting with lower respiratory tract infection: a case report

Somesh Saha, Aakash Guha Roy, Shramana Sarkar, Shramana Deb, Ritwick Mondal

Abstract


Neutropenic enterocolitis (NEC) has been widely reported in adults with myelofibrotic disorders, solid malignant tumors, bone marrow transplantation as well as in myelotoxic chemotherapy. Here we reported a case of a 66-year-old non-diabetic, hypertensive female without any prior history of immunosuppression or any underlying malignancy or related chemotherapy; who presented with severe dyspnoea, low grade fever and cough. Followed by a course of effective conservative management and initial stabilization, on investigation her TLC was found to be abnormally low with severe neutropenia and a hyperinflammatory response induced myelosuppression with LRTI was suspected. Subsequently, subcutaneous G-CSF, broad spectrum antibiotics were initiated along with supportive management. She developed abdominal distension, diffused pain and tenderness with hypoactive bowel on the following day. After 3 days of G-CSF trial, neutrophil count started to increase along with her overall improvement. CECT was performed with positive findings of multiple colonic short segment involvement without any stricture, pericolic fat stranding and perforation; reflecting towards a resolving neutropenic enteropathy.


Keywords


Neutropenia, Enteropathy, G-CSF, Myelosuppression

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References


Nguyen DN, Sangild PT. Pathogenesis and biomarkers for necrotizing enterocolitis: getting any closer? E Bio Medicine. 2019;45:13-4.

Liu T, Zhang L, Joo D, Sun SC. NF-κB signaling in inflammation. Signal Transduct Target Ther. 2017;2:17023.

Miedema KG, Bont ES, Elferink RF, Vliet MJV, Nijhuis CSMO, Kamps WA, et al. The diagnostic value of CRP, IL-8, PCT, and sTREM-1 in the detection of bacterial infections in pediatric oncology patients with febrile neutropenia. Support Care Cancer. 2011;19(10):1593-600.

Gomez L, Martino R, Rolston KV. Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis. 1998;27(4):695-9.

Alt B, Glass NR, Sollinger H. Neutropenic enterocolitis in adults. Review of the literature and assessment of surgical intervention. Am J Surg. 1985;149(3):405-8.

Bavaro F. Neutropenic enterocolitis. Curr Gastroenterol Rep. 2002;4(4):297-301.

Machado NO. Neutropenic enterocolitis: a continuing medical and surgical challenge. N Am J Med Sci. 2010;2(7):293-300.

Chakravarty K, Scott DG, McCann BG. Fatal neutropenic enterocolitis associated with sulphasalazine therapy for rheumatoid arthritis. Br J Rheumatol. 1992;31(5):351-3.

Or R, Mehta J, Nagler A, Craciun I. Neutropenic enterocolitis associated with autologus bone marrow transplantation. Bone Marrow Transplant. 1992;9(5):383-5.

Alt B, Glass NR, Sollinger H. Neutropenic enterocolitis in adults: Review of the literature and assessment of surgical intervention. Am J Surg. 1985;149(3):405-8.

Katz JA, Wagner ML, Gresik MV, Mahoney DH, Fernbach DJ. Typhilitis: An 18 year experience and post mortum review. Cancer. 1990;65(4):1041-7.

Cohen A, Owolabi FS, Dowdell-Smith CP, Laufman J, Iacobas I, Bass L, et al. Weakness, anemia, and neutropenia in a 9-year-old girl with influenza. Pediatrics. 2019;145(5):20192574.

Yeh YM, Chen YP, Wu HC, Su WC, Chen TY. Cytomegalovirus-related neutropenic enterocolitis with negative CMV antigenemia as the initial presentation in an acute myeloid leukemia patient. Ann Hematol. 2009;88(3):279-80.

Houen G, Trier NH. Epstein-Barr virus and systemic autoimmune diseases. Front Immunol. 2021;11:587380.

Mukherjee A, Tangri R, Verma N, Gautam D. Chronic disseminated histoplasmosis bone marrow involvement in an immunocompetent patient. Indian J Hematol Blood Transfus. 2010;26(2):65-7.

Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology. 2003;226(3):668-74.

Starkebaum G. Use of colony-stimulating factors in the treatment of neutropenia associated with collagen vascular disease. Curr Opin Hematol. 1997;4(3):196-9.

Newman KA, Akhtari M. Management of autoimmune neutropenia in Felty's syndrome and systemic lupus erythematosus. Autoimmun Rev. 2011;10(7):432-7.

Starkebaum G. Chronic neutropenia associated with autoimmune disease. Semin Hematol. 2002;39(2):121-7.