title: Esophageal erosion as a possible bacterial entry site in an acute lymphoblastic leukemia patient with sepsis.
abstract: A 69-year-old man with relapsed acute lymphoid leukemia was treated with adriamycin, vincristine, and prednisolone. During this chemotherapy, the patient developed sepsis and meningitis. Although many kinds of antimicrobial drugs, including imipenem, meropenem, amphotericin-B, and gamma-globulin were administered, the patient died of respiratory failure. A positive result for Enterococcus faecalis was obtained in both blood and cerebrospinal fluid culture. Autopsy revealed multiple small erosions in the lower esophagus. Histopathological examination showed multiple nuclear inclusion bodies of herpes simplex virus in the squamous epithelial cells at the edge of the erosions. Moreover, proliferation of micrococci was observed at the base of the erosions and in the lumina of the submucosal small vessels. These findings suggested that E faecalis entered the blood circulation from this lesion. In many patients with febrile neutropenia, the pathogenesis of infection remains unclear. Our case seems significant for clarifying the focus and pathogenesis of febrile neutropenia.
authors.affiliation: Second Department of Pathology, Fukui Medical University, Yoshida-gun, Fukui, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikegaya
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshida
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Hironobu
authors.initials: H
authors.lastname: Naiki
authors.forename: Takanori
authors.initials: T
authors.lastname: Ueda
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001344:Autopsy; D013293:Enterococcus faecalis; D004935:Esophageal Diseases / Q000382:microbiology*; D017809:Fatal Outcome; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000382:microbiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D012131:Respiratory Insufficiency; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology / Q000473:pathology