Typhlitis in childhood cancer.
BACKGROUND
Typhlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging (ultrasonography and computed tomography [CT] scans) variables related to the diagnosis, risk, and outcome of typhlitis.


METHODS
The authors reviewed the records of patients who had typhlitis (bowel wall thickness > or = 0.3 cm plus clinical findings) during treatment at St. Jude Children's Research Hospital (Memphis, TN) between 1990 and 2001. They assessed whether duration of typhlitis was related to bowel wall thickness, extent of colonic involvement, ascites, demographics, primary diagnosis, symptoms of typhlitis, or duration of neutropenia. To identify risk factors for typhlitis, the authors compared the demographic data and previous drug therapy of 78 patients who had typhlitis and 1231 identically treated children who did not.


RESULTS
Of 3171 children, 83 (2.6%) developed typhlitis. Frequent symptoms were abdominal pain (91%), fever (84%), abdominal tenderness (82%), and diarrhea (72%). Twelve percent of the patients were not neutropenic. Duration of typhlitis was associated with bowel wall thickness measured by ultrasonography (n = 68; P = 0.05) but not CT scan (n = 48; P = 0.67) and was associated with duration of neutropenia (P = 0.02), fever (P = 0.01), and abdominal tenderness (P = 0.04). Age >16 years at cancer diagnosis was the only demographic factor associated with typhlitis (P = 0.03). Two patients died of typhlitis.


CONCLUSIONS
Ultrasonography was a useful imaging modality for children with suspected typhlitis. The classic triad of abdominal pain, fever, and neutropenia may be absent. The severity of typhlitis was related to the duration of neutropenia and the presence of fever or abdominal tenderness.
McCarville
M Beth
MB
Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. beth.mccarville@st jude.org
Adelman
C Scott
CS
Li
Chenghong
C
Xiong
Xiaoping
X
Furman
Wayne L
WL
Razzouk
Bassem I
BI
Pui
Ching-Hon
CH
Sandlund
John T
JT
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020345:Enterocolitis, Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000970:Antineoplastic Agents