title: Febrile neutropenia as the presenting sign of appendicitis in an adolescent with acute myelogenous leukemia.
abstract: The diagnosis and management of a surgical abdomen in patients with acute leukemia is quite difficult because of the complications and treatment of disease itself. A 13-year-old boy with acute myelogenous leukemia developed 2 episodes of febrile neutropenia during induction therapy. The second one was treated with a 5-day course of parenteral antimicrobial therapy, but the patient then presented with right lower quadrant abdominal tenderness, guarding, and rebound tenderness. Abdominal ultrasonography and computed tomography revealed appendicitis. Conservative medical management was unsuccessful, and appendectomy was performed 5 days after appendicitis was diagnosed. The patient's clinical manifestations resolved 5 days later. The case illustrates that fever may be the first manifestation of appendicitis in a child with acute myelogenous leukaemia who is neutropenic. Surgery is acceptable as first-line treatment in such cases.
authors.affiliation: Baskent University Faculty of 0Medicine, Department of Haematology, Ankara, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Ozyurek
authors.forename: Serdar
authors.initials: S
authors.lastname: Arda
authors.forename: Servet
authors.initials: S
authors.lastname: Ozkiraz
authors.forename: Bulent
authors.initials: B
authors.lastname: Alioglu
authors.forename: Unser
authors.initials: U
authors.lastname: Arikan
authors.forename: Namik
authors.initials: N
authors.lastname: Ozbek
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D000293:Adolescent; D000583:Amikacin / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000601:surgery; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis*; D005334:Fever / Q000209:etiology*; D006801:Humans; D007948:Leukemia, Monocytic, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D009950:Ornidazole / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D009950:Ornidazole; D000666:Amphotericin B; D000077723:Cefepime; D000583:Amikacin