UMEM Educational Pearls

Category: Critical Care

Title: Enterocolitis in the Critically-Ill Neutropenic Patient

Keywords: neutropenic fever, typhlitis, necrotizing enterocolitis, sepsis, septic shock (PubMed Search)

Posted: 2/12/2019 by Kami Windsor, MD (Updated: 9/21/2019)
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Neutropenic enterocolitis can occur in immunosuppressed patients, classically those being treated for malignancy (hematologic much more commonly than solid tumor). When involving the cecum specifically, it is known as "typhlitis."

It should be considered in any febrile neutropenic patients with abdominal pain or other symptoms of GI discomfort (diarrhea, vomiting, lower GI bleeding), and can be confirmed with CT imaging.

A recent study found that invasive fungal disease, most often candidemia, occurred in 20% of febrile neutropenic patients with CT-confirmed enteritis, a rate that increased to 30% if the patient was in septic shock.

 

Take Home: 

1. Have a lower threshold for abdominal CT imaging in your patients with febrile neutropenia and abdominal pain/GI symptoms, especially if they are critically ill.

2. Consider addition of IV antifungal therapy if they are hemodynamically unstable with enterocolitis on CT.

References

Duceau B, Picard M, Pirrachio R, et al. Neutropenic enterocolitis in critically ill patients: Spectrum of the disease and risk of invasive fungal disease. Crit Care Med. 2019. [Epub ahead of print] doi: 10.1097/CCM.0000000000003687.