Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary gut involvement by Aspergillus is an exceedingly rare and often a fatal complication of intensive chemotherapy in patients with acute leukaemia. We report a 46-yr-old patient with granulocytic sarcoma of the testis. He received acute myeloid leukaemia type treatment with ADE chemotherapy (Cytosine Arabinoside, Daunorubicin and Etoposide). While neutropenic he presented with pyrexia, abdominal pain and massive abdominal distention. He was treated with intravenous antibiotics and antifungals according to our usual institutional protocol without any response. He was found to have toxic megacolon on plain X-ray and subsequently underwent total colectomy and ileostomy. The colon histology showed Aspergillus fungal hyphae infiltrating the bowel wall. There was no any evidence of pulmonary, hepatic, splenic or renal lesions on the computerised tomography scan. Following colectomy, he was treated with 2 wk of antifungal treatment. He recovered well and was discharged home. The increased awareness, high degree of clinical suspicion of unusual presentation and early surgical intervention with aggressive antifungal treatment, has a key role in the management of these rare and often fatal cases.
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PMID:Invasive aspergillosis localised to the colon presenting as toxic megacolon. 1732 84

We report here on the clinical courses of three cases of acute appendicitis during a period of myelosuppression after chemotherapy for acute leukemia. The patients were two boys and one girl with a mean age 11 years (range, 10-12). Two of the patients had acute myeloid leukemia (AML) in subtypes M1 and M2, while the third had acute lymphoblostic leukemia of subtype L1 (FAB classification). All patients had clinical features of fever, abdominal pain, and elevations of C-reactive protein. However, the typical peritoneal signs were blunted and developed transiently in two cases. All patients were diagnosed as having appendicitis with abdominal computed tomography scan (CT), and proceeded to appendectomy. With perioperative support utilizing antibiotics, antifungal agents, blood components, and granulocyte-colony stimulating factor, surgical intervention was successfully performed, and all patients were able to undergo chemotherapy courses shortly after surgery. Histological examinations of the appendectomy specimens showed infiltration of most of the lymphoid cells and a few neutrophils in the wall of the appendix. Enhanced CT was useful in diagnosing appendicitis, which needs to be considered in cases presenting with clinical symptoms such as described here. Because of a high mortality rate after appendix perforation, immediate surgical intervention with sufficient perioperative support should be performed.
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PMID:[Acute appendicitis during bone marrow suppression following chemotherapy for acute leukemia; report of three cases]. 1744 80

Granulocytic sarcoma is an extramedullary tumor associated with acute myelogenous leukemia (AML) and it is rarely seen in the female genital tract. We report an unusual case of granulocytic sarcoma of the uterus and fallopian tube in an AML patient who presented with vaginal bleeding and persistent abdominal pain. She was under chemotherapy. Biopsy did not reveal the diagnosis. After laparoscopic examination, hysterectomy with bilateral salpingo-oophorectomy was performed. Pathology showed atypical myeloid cells infiltrating the muscle bundles which was consistent with granulocytic sarcoma involving the uterus and right fallopian tube. Immunohistochemistry confirmed the diagnosis. The patient is in complete remission for AML and being followed-up for granulocytic sarcoma. Granulocytic sarcoma of the uterus and fallopian tube is very rare, and in AML patients with abnormal uterine bleeding but negative endometrial biopsy it should still be considered in the differential diagnosis.
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PMID:Granulocytic sarcoma involving the uterus and right fallopian tube with negative endometrial biopsy. 1771 90

Spontaneous remissions of acute myeloid leukemia (AML) have been reported in association with infection. Here, we report a case of spontaneous remission of AML in a 47-year-old Saudi Arabian male patient who presented with a few weeks history of recurrent abdominal pain, vomiting and fever. He was diagnosed with acute monocytic leukemia (AML, FAB M5b) and a perforated bowel. He also had Clostridium septicum bacteremia and thus chemotherapy was deferred. He received supportive therapy and intravenous antibiotics. Six weeks later, he achieved spontaneous and complete remission lasting for about 4 months. The remission and relapse were documented by bone marrow examination. Similarly, previous reports of spontaneous remission of AML were short lived and were followed by relapse and progression.
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PMID:Spontaneous remission of acute monocytic leukemia after infection with Clostridium septicum. 1782 21

Neutropenic enterocolitis (NE) and acute appendicitis are life-threatening conditions that develop in children with severe or prolonged neutropenia secondary to acute leukemia and lymphoma. The medical records of 118 patients who were treated for acute lymphoblastic leukemia (69 patients), acute myelogenous leukemia (22 patients), or aplastic anemia (27 patients) between 1997 and 2006 in our hospital pediatric hematology department were examined retrospectively. NE was diagnosed in 11 patients (age range, 2.5-16 years) on the basis of clinical and laboratory features. Two of these 11 patients had appendicitis in addition to NE. Conservative treatment was favored for all patients, but 1 patient with acute appendicitis underwent surgery. Neutropenic patients with a hematologic malignancy and abdominal pain should receive their diagnoses immediately and undergo treatment. NE and acute appendicitis should always be considered in the differential diagnosis of abdominal pain. Conservative treatment must be chosen initially for patients with NE, and these patients should be evaluated carefully for surgery. The criteria for the surgical process are the same as those for immunocompetent children. In addition, the close monitoring of hematologic factors is necessary.
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PMID:Neutropenic enterocolitis in children with acute leukemia or aplastic anemia. 1805 46

Aspergillosis is a common fungal infection in immunocompromised patients undergoing chemotherapy. The incidence of invasive fungal infection in these patients has increased dramatically in recent years. We report a case of small-bowel infarction caused by Aspergillus in a 48-year-old man who was receiving chemotherapy for acute myeloid leukemia. On day 20 after the start of chemotherapy, right lower abdominal pain and rebound tenderness developed, with a high fever. A contrast-enhanced computed tomography scan showed a semicircular perfusion defect in the ileum. Thus, we performed partial resection of the ileum with primary anastomosis. Macroscopically, the ileum had mucosal ulcerations. Microscopically, there was transmural necrosis with microperforation and Aspergillus invading necrotic tissue and blood vessels. The patient had an uneventful postoperative course and was discharged 14 days after the procedure. Intestinal aspergillosis is rare and associated with high mortality. Thus, it should be considered in the differential diagnosis of neutropenic patients with sudden abdominal pain and fever.
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PMID:Localized small-bowel infarction caused by Aspergillus during chemotherapy for acute myeloid leukemia: report of a case. 1856 Sep 70

Differential diagnosis of a focal splenic lesion in the context of acute leukemia is quite challenging. A 58-year-old woman presented with a 3-day history of fever and abdominal pain. The results of hematological work-up were consistent with acute myeloblastic leukemia (M2, French-American-British classification). Being susceptible to infection in this leukemic patient with severe neutropenia, a diagnosis of splenic abscess was straightforward, plausibly supported by the radiographic findings. Despite empiric broad-spectrum antibiotic treatment, hyperleukocytosis with resultant pulmonary leukostasis supervened. Histological sections from ultrasound-guided percutaneous core-needle biopsy of the spleen confirmed the diagnosis of myeloid sarcoma. However, delayed leukemia-targeted therapy, unfortunately, resulted in catastrophic mortality. It should be addressed that, even with the advent of modern imaging modalities, there can be a diagnostic pitfall when managing solitary splenic lesion in acute leukemic patients without histological examination. Early recognition with prompt chemotherapeutic intervention can be life saving.
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PMID:An unusual case of febrile neutropenia: acute myeloid leukemia presenting as myeloid sarcoma of the spleen. 1871 48

Granulocytic sarcoma is an extramedullary tumor of immature myeloid cells which is often a forerunner to the development of acute myelogenous leukemia. Granulocytic sarcoma of the gastrointestinal tract frequently involves the small intestine and often presents with abdominal pain and obstruction. Our patient presented with a proximal jejunal mass causing intussusception and obstruction. This type of manifestation has never before been reported. A laparoscopy-assisted resection of the affected portion of jejunum was performed for him. The initial pathological findings were high-grade non-Hodgkin's lymphoma; immunohistochemistry confirmed a diagnosis of granulocytic sarcoma. After a follow-up of 14 months, there was no evidence of leukemia. This condition is often mistaken for lymphoma and confirmation is necessary by immunohistochemistry. Chemotherapy is the treatment of choice and surgery is indicated only in the event of complications, such as bowel obstruction, bleeding, or perforation. The prognosis of granulocytic sarcoma is similar to that of myeloid leukemia.
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PMID:Laparoscopic management of an obstructing granulocytic sarcoma of the jejunum causing intussusception in a nonleukemic patient: report of a case. 1956 50

In May 2006, a 72-year-old man with acute myelogenous leukemia (M4Eo) was admitted to our hospital. He had been receiving antiandrogen treatment for prostate cancer (after an operation in 1998) and treatment for diabetes mellitus. He received chemotherapy according to the JALSG GML200 protocol, which led to complete remission; however, in January 2007, his leukemia recurred. CAG combination chemotherapy also resulted in complete remission by May 2007. In August 2007, he developed multiple liver tumors, abdominal pain, and fever. Contrast-enhanced computed tomography revealed hypovascular tumors in both early and delayed phases. Angiography showed ring-like tumor staining and a massive tumor, similar to those seen in metastatic hepatocellular carcinomas (HCCs). He eventually died because of aggressive enlargement of liver tumors during the following month accompanied by the simultaneous recurrence of leukemia and unsuccessful embolization of the hepatic artery. Autopsy specimens showed fibrosis and considerable iron deposition in the liver, suggested secondary hemochromatosis due to transfusion. We also detected multiple moderately differentiated primary HCCs. Secondary hemochromatosis, androgen imbalance, and humoral factors from leukemic cells were believed to be the causes of the rapid onset and development of HCCs.
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PMID:Multiple hepatocellular carcinomas developed 15 months after commencement of chemotherapy for elderly acute myelogenous leukemia. 2000 36

Leukemias are the commonest childhood malignancy in West Bengal. This study was undertaken on 75 children at NRS Medical College, West Bengal to determine the distribution of signs and symptoms of leukemia and to identify unusual clinical features. After obtaining clinical history, physical examination, hematological and radiological investigations were performed. Acute lymphoblastic leukaemia (ALL, 72%) was the commonest followed by acute myeloid leukaemia (AML, 18.7%). Common symptoms and signs were fever (85.3%), pallor (64%), hepatomegaly (72%), splenomegaly (60%) and lymphadenopathy (50.7%). The uncommon signs and symptoms were abdominal pain (9.3%), joint pain (9.3%), hematemesis and malena (8%), diarrhea (5.3%), proptosis (2 cases), dysphagia, mediastinal mass and parotid swelling (1 case each). Uncommon clinical presentations lead to delay in diagnosis in some cases. Awareness of uncommon signs and symptoms of childhood leukemia together with laboratory tests may help in earlier diagnosis and proper management of the patients.
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PMID:Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features. 2059 69


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