title: Concomitant typhlitis and Clostridium difficile colitis developed after first R-CHOP chemotherapy in a non-Hodgkin lymphoma patient.
abstract: Typhlitis or neutropenic enterocolitis (NEC) is a life-threatening condition that occurs in neutropenic patients. Early recognition is crucial owing to high death rate. We present a case of a 54-year-old man, diagnosed with non-Hodgkin lymphoma who received a first cycle of rituximab, cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), prednisolone (R-CHOP) chemotherapy 10 days prior presenting. He developed fever, mucositis, watery diarrhoea and right lower quadrant pain with rebound tenderness. He also had neutropenia, with an absolute neutrophil count of zero. CT abdomen confirmed the diagnosis of typhlitis, demonstrating characteristic terminal ileum, caecal and right-sided colon involvement. Moreover, stool PCR was also positive for toxigenic Clostridium difficile. Therefore, the patient was diagnosed with concomitant typhlitis and C difficile-associated diarrhoea (CDAD). He was empirically treated with intravenous cefepime, intravenous metronidazole and oral vancomycin. His symptoms resolved in 10 days. This case illustrated a successful medical treatment of typhlitis in concomitance with CDAD.
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA. junpapap@einstein.edu
authors.forename: Parichart
authors.initials: P
authors.lastname: Junpaparp
authors.forename: Saranya
authors.initials: S
authors.lastname: Buppajarntham
authors.forename: Fernando Vargas
authors.initials: FV
authors.lastname: Madueno
authors.forename: Gabor
authors.initials: G
authors.lastname: Varadi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011241:Prednisone / Q000009:adverse effects; D011859:Radiography; D000069283:Rituximab; D053706:Typhlitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D014640:Vancomycin / Q000627:therapeutic use; D014750:Vincristine / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D002511:Cephalosporins; C571759:R-CHOP protocol; D008795:Metronidazole; D000069283:Rituximab; D014750:Vincristine; D014640:Vancomycin; D004317:Doxorubicin; D000077723:Cefepime; D003520:Cyclophosphamide; D011241:Prednisone