Sonographic and Clinical Features of Typhlitis in Pediatric Cancer Patients on Chemotheaphy at Tikur Anbessa Specialized Hospital, Ethiopia, 2021.

Background: Typhlitis, (neutropenic enterocolitis), is a necrotizing enteropathy of the right colon, and is characterized by the clinical triad of fever, abdominal pain, neutropenia and imaging findings of right-side colonic inflammation. It is seen in the setting of severe neutropenia in immune suppressed patients who undergo treatment for malignancies, in those who have organ transplant(s) or congenital or other acquired immunosuppression. We report the clinical and imaging findings of typhlitis in pediatric cancer patients who had received chemotherapy in the largest tertiary center in Addis Ababa, Ethiopia over a period of 20 months. Methods: The medical records of hospitalized cancer patients on treatment and with suspected typhlitis and with ultrasound reports were screened (November 2018- July 2020). Retrospective analysis of the clinical and sonographic data of those with typhlitis was done. Results: Typhlitis was identified in 4.2% (12/286) of the patients on chemotherapy. 11 (91.7%) had hematologic malignancies (leukemia, lymphoma), one had a solid tumor (Head and neck embryonal RMS). Most (83.3%) had abdominal pain, diarrhea and neutropenia. Fever was identified in 67.7%. All had ultrasound evidence of typhlitis. and treated with IV antibiotics. Neither complications requiring surgical intervention nor death were seen. Conclusion: The magnitude of disease was comparable to what had previously been reported in other studies. While the presence of clinical a triad should prompt suspicion for the diagnosis, sonography can be used for confirmation and follow up obviating radiation, with good access in a resource limited setting.

Intussusception caused by typhlitis: a rare complication in a patient with acute lymphoblastic leukemia after chemotherapy.

INTRODUCTION: Intussusception, which is common in pediatric patients but rare in adults with leukemia, usually presents with an intralumenal lesion as a lead point in adults. CASE REPORT: We herein report the case of a 38-year-old female who developed right lower quadrant abdominal pain and fever on day 16 of chemotherapy. Abdominal computed tomography showed ileocecal intussusception. The patient underwent surgery, and the definitive pathological diagnosis was typhlitis leading to intussusception. Albeit very rare in adults, typhlitis-induced intussusception should be suspected in those with leukemia presenting with abdominal pain.

Clostridium difficile colitis: CT findings and differential diagnosis.

Clostridium difficile infection (CDI) is a severe and potentially deadly infectious colitis whose incidence is dramatically increasing in the last decades, with more virulent strains. CDI should be suspected in case of unexplained diarrhea and abdominal pain in patients with a recent history of antibiotic use and healthcare exposures; diagnosis is based on a combination of clinical and laboratory findings with demonstration of C. difficile toxins by stool test. The advantages of contrast-enhanced computed tomography (CECT) are the noninvasiveness and the ability to evaluate both the colonic wall and the adjacent soft tissues. Considerable overlap exists between the CECT findings of CDI and those of colitis of other origins, such as typhlitis, ischemic colitis, graft-versus-host disease, radiation colitis and inflammatory bowel diseases; however, some features may help distinguish between these conditions. This paper provides a comprehensive overview of the imaging features of Clostridium difficile colitis and its mimics, with a view to assist the radiologist in reaching the correct diagnosis.

Ultrasound diagnosis of typhlitis.

PURPOSE: Typhlitis, also known as neutropenic colitis, is a rare inflammatory condition and a potentially life-threatening disease process that typically involves the cecum. Delay in diagnosis may lead to a fatal prognosis with a death rate of 21-48%. Ultrasound evaluation of right lower quadrant may lead to an accurate and rapid diagnosis. METHODS: We describe the case of a 59-year-old female with advanced Churg-Strauss syndrome treated with cyclophosphamide, with acute right lower quadrant pain. RESULTS: Ultrasound was the first diagnostic step in the diagnosis of typhlitis. Sonographic findings were comparable to CT imaging. CONCLUSIONS: Bowel bedside ultrasound evaluation in emergency settings may lead to a prompt and definitive diagnosis. Although CT is considered the gold standard in the diagnosis and staging of neutropenic colitis, ultrasound was able to identify the pathology accurately. Ultrasound findings of typhlitis are highly characteristic, showing circumferential wall thickening with predominant submucosa.

Clinical Salmonellosis in a Closed Colony of Blood Donor Cats.

An adult feline blood donor, group-housed in a closed colony with other blood donor cats in a laboratory animal facility, developed anorexia, abdominal pain, an abdominal mass effect, and hemorrhagic diarrhea. Ultimately Salmonella infection was diagnosed. The index cat and 2 additional cats in the closed colony had clinical signs consistent with Salmonella and yielded Salmonella serotype 4,12:i:- in fecal cultures. An extensive search for the source of Salmonella was unrewarding. With the implementation of individual housing and additional barrier precautions, combined with antibiotic treatment of the index case, all the cats survived and subsequently had multiple, negative Salmonella PCR test results. This case report highlights the potential for unlikely infections to occur, even in a closed colony of research animals, as well as the important role of sanitation in the elimination of this enteric pathogen.

Concomitant typhlitis and Clostridium difficile colitis developed after first R-CHOP chemotherapy in a non-Hodgkin lymphoma patient.

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.

Pemetrexed-induced typhlitis in non-small cell lung cancer.

Pemetrexed is U.S. Food and Drug Administration-approved as a second line, single-agent treatment of recurrent metastatic non-small cell lung cancer. Gastrointestinal side effects, including stomatitis, diarrhea, and vomiting are reported to be less than 1% and rarely severe. In the premetrexed clinical trial database of 1327 patients, various types of colitis were reported by a total of nine patients (0.6%). Typhilitis is a gastrointestinal complication of chemotherapy, which presents as fever and abdominal pain. The diagnosis is supported by the findings of bowel wall thickening on computed tomographic imaging. Typhilitis is usually seen in the setting of severe chemotherapy-induced neutropenia for acute leukemia. Nevertheless, it is increasingly recognized as a complication of therapy in solid tumors. We present the first documented case of typhilitis after treatment with pemetrexed and successful therapy with supportive treatment.

Typhlitis; is it just in immunocompromised patients?

BACKGROUND: Typhlitis is necrotizing inflammation of the cecum manifested by febrile right lower quadrant abdominal pain. All cases in literature have been described in immunocompromised such patients with hematological or solid malignancies, patients with neutropenia, patients with AIDS, and patients following immunosuppressive therapy for transplants. CASE REPORT: We report a case of a 72 year old non-immunocompromised patient who developed fever, nausea, vomiting and severe right lower quadrant pain. Computed Tomography (CT) of the abdomen and pelvis showed circumferential thickening of the cecum as well as inflammatory stranding of the adjacent mesenteric fat. The patient was treated with fluids and antibiotics. The patient's symptoms resolved over a period of few days. CONCLUSIONS: We believe this case represents an example of typhlitis in non-immunocompromised patient, the first such case reported. Therefore, typhlitis may present in elderly patients even in the absence of neutropenia or immunosuppression.

Caecal epiploic appendagitis: an unlikely occurrence.

AIM: To determine whether epiploic appendagitis occurs in the caecum. METHODS: From 2000-2006, 58 cases with classic computed tomography (CT) features of acute epiploic appendagitis (focal round or oval fat density immediately adjacent to the colon with surrounding oedema and stranding, with or without a central area of high attenuation) were identified from a radiology information system and available for review on the picture archiving and communication system (PACS). Cases were assigned to one of six colonic segments: rectum, sigmoid, descending colon, transverse colon, ascending colon, and caecum. The Blyth-Still-Casella procedure was used to derive an exact upper bound on the likelihood of epiploic appendagitis occurring within the caecum. RESULTS: Twenty-eight cases occurred in the sigmoid colon, 16 in the descending colon, four in the transverse colon, and 10 in the ascending colon. No cases of acute epiploic appendagitis were identified in the caecum. Four cases of prospectively dictated caecal epiploic appendagitis were identified from the database. Retrospective review of these cases showed two cases to be epiploic appendagitis of the ascending colon. The third case demonstrated peritoneal thickening without evidence of an inflamed epiploic appendage. The fourth case was caecal diverticulitis. Based on these findings there is 95% confidence that no more than 4.6% of patients with epiploic appendagitis will show this condition within the caecum. CONCLUSION: In the authors' experience, epiploic appendagitis does not occur in the caecum. Therefore, it is an unlikely cause for an inflammatory process in this region and other conditions should be considered.

Double invasive fungal infection and typhlitis in children with acute lymphoblastic leukemia.

Invasive fungal infection is one of the major causes of morbidity and mortality in immunocompromised patients. The occurrence of two invasive fungal infections in one patient at the same time is quite rare. Here the authors report on two adolescent patients with acute lymphoblastic leukemia who developed combined invasive pulmonary aspergillosis and hepatosplenic candidiasis during chemotherapy. They were treated with liposomal amphotericin B, but one of them died due to massive pulmonary hemorrhage during recovery from neutropenia.

[Typhlitis: report of a case and review of the literature]. / Typhlite: à propos d'une observation et revue de la littérature.

INTRODUCTION: Typhlitis is a rare condition, characterized by necrotizing inflammation of the colon. It occurs mainly in neutropenic patients receiving chemotherapy for leukemia. EXEGESIS: We report the case of a 64-year-old woman with T-cell lymphocytic leukaemia, who exhibited asymptomatic reactivation of cytomegalovirus infection and developed subsequently typhlitis. CONCLUSION: The pathological mechanisms of typhlitis remain unclear in neutropenic patients. The role of cytotoxic drugs as well as both bacterial overgrowth and translocation has been postulated. In our patient, asymptomatic reactivation of cytomegalovirus infection may have increased chemotherapeutic-agents-digestive toxicity.

Diseases of the cecum: a CT pictorial review.

Cecal pathology is commonly encountered and may represent a diagnostic challenge in patients with either acute or chronic clinical presentations. Although appendicitis accounts for the majority of surgical conditions presenting with right lower quadrant pain, readers should be aware of the broad spectrum of cecal pathologies and characteristic CT findings, which can be useful in establishing the correct diagnosis.