Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Colitis is a life-threatening complication of aplastic anemia which occurs during periods of profound neutropenia. Four cases of this previously unreported association are described here. A syndrome of fever, watery diarrhea, and generalized abdominal pain and tenderness occurred in close temporal relationship to development of severe neutropenia (less than 50 neutrophils per cu mm). None of the patients had received antibiotics, nor had a history of previous episodes of colitis. Three had cultures positive for colonic organisms during the episodes. In only one instance was the correct diagnosis made without operation. Gross evidence of disease was found in the cecum, the transverse colon, and rectosigmoid in three patients, but the true extent of disease was underestimated. Microscopic examination of the two resected specimens showed extensive mucosal and variable submucosal necrosis with invasion of the colonic wall by bacteria. Acute inflammatory changes were absent. With profound neutropenia, the colon wall lacks resistance to invasion by the resident microflora. The condition is probably best treated without operation. If first recognized at laparotomy, resection should be avoided.
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PMID:Neutropenic colitis and aplastic anemia: a new association. 684 59

A 66-year-old woman presented with a 1-day history of sudden onset of generalised abdominal pain associated with fever and vomiting. She was previously diagnosed with left breast cancer 2 months ago and completed a course of chemotherapy 1 week prior to presentation. She was clinically unwell with generalised tenderness in her abdomen. Blood investigations showed severe neutropenia. A CT scan was requested which reported a marked oedematous swelling of the transverse colon with features suggestive of a contained perforation. The decision was made to operate. Intraoperatively, the transverse colon was found to be thickened with omentum adherent focally around the distal third. A right hemicolectomy was performed with an end ileostomy and mucus fistula. The patient made a successful recovery and was discharged within 7 days of presenting. Pathology reported typical features of neutropenic enterocolitis affecting the transverse colon with a normal terminal ileum, caecum and ascending colon.
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PMID:Neutropenic enterocolitis affecting the transverse colon: an unusual complication of chemotherapy. 2479 23

Neutropenic enterocolitis (NE) also known as typhlitis is a serious condition that has been described in immunosuppressed hosts including patients with leukemia, HIV and in patients on chemotherapy. We present the first case of female on sulfasalazine for psoriatic arthritis, otherwise healthy, who was diagnosed with NE involving the cecum and rectum. This adds up to the cases of NE diagnosed in nononcologic conditions. A 65-year-old female with a history of psoriatic arthritis on sulfasalazine, presented to the emergency department (ED) after an episode of syncope. She was complaining of a fever and mild generalized abdominal pain. Physical exam was remarkable for peri-umbilical tenderness. Severe neutropenia and acute kidney injury were found on blood work. CT scan of the abdomen showed evidence of colitis, involving the cecum, ascending colon and rectum, which in light of neutropenia was consistent with NE. Clostridium difficile colitis was ruled out. Intravenous fluids and broad-spectrum antibiotics were initiated, and sulfasalazine was discontinued. The patient was subsequently afebrile and was out of neutropenia by day 3 without the need for granulocyte-macrophage colony-stimulating factor (GM-CSF). By day 5, the patient was pain free and was discharged. Even though NE is primarily described in the setting of malignancies and chemotherapy, one should keep in mind that this entity can occur in people on any immunosuppressive therapy. Early discontinuation of sulfasalazine and conservative management were essential in the treatment of NE in this case. Whether neutropenia precipitates colitis or the latter causes agranulocytosis by bone marrow suppression through cytokines remains to be proved. The diagnosis of medication-related adverse reactions remains a big challenge for clinicians and therefore requires a high index of suspicion. Resolution of the symptoms can simply occur with the discontinuation of the offending drug and often does not require extensive workup or treatments that might cause harm to the patient's health.
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PMID:Neutropenic Enterocolitis Secondary to Sulfasalazine in a Woman With Psoriatic Arthritis. 3267 Jul 12