0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

Typhlitis is inflammation or

necrosis of the ileum and

cecum in neutropenic patients.

The mortality rate is 40—50%.

Neutropenic Fever

Neutropenic fever is defined as sustained temperatures < 38 °C or single tempera-

ture<38.3°Cin the presence of neutropenia (ANC <500 cells/μL). Fever may

be the only presenting sign. Risk of death increases as the ANC decreases.

CAUSES

Sources of infection:

■ Most likely sources include respiratory, urinary, GI, and line infection.

■ Bacterial infection

■ Gram-negative (Pseudomonas, E. coli, Proteus, Klebsiella)

■ Gram-positive (Staphylococcus, Streptococcus)

■ Viral infection

■ CMV, herpes

■ Opportunistic infections

SIGNS/SYMPTOMS

■ Range from minimal symptoms to septic shock

DIAGNOSIS

■ CBC, chemistries, LFTs, coagulation panel

■ Cultures from indwelling catheter, blood, urine, sputum, stool

■ CXR

TREATMENT

■ Hemodynamic support

■ Initiate broad spectrum antibiotic

■ Antipseudomonal aminoglycoside plus antipseudomonal PCN or

■ Antipseudomonal third generation cephalosporin (Ceftazidime) plus

vancomycin

■ Control source of infection with debridement if appropriate or surgical

consultation for intra-abdominal infections.

A 70-year-old male with a history of prostate cancer presents with low back

pain. The pain is worse in the recumbent position and worse with palpa-

tion. He describes retaining urine and problems with ambulation. Exam

shows decreased rectal tone, postvoid residual of 500 mL, and motor/sensory

changes. What is your suspected diagnosis and next step in management?

Acute spinal cord compression; administer dexamethasone and call neuro-

surgery and/or radiation oncologist.

Spinal Cord Compression

Presents with back pain at the level of compression with motor, sensory, auto-

nomic dysfunction below the level of compression. Etiologies include multi-

ple myeloma, lymphoma, metastatic cancer (lung, breast, prostate). The most

common site is the thoracic spine followed by lumbar and cervical spine.

SIGNS/SYMPTOMS

■ Back pain, bilateral motor weakness, sensory changes, bladder/bowel

dysfunction

■ Vertebral tenderness, motor weakness, abnormal rectal tone, loss of anal

wink, areflexia, saddle anesthesia