ABSTRACT. Acute human immunodeficiency virus (HIV) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-yearold boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for HIV infection was a history of unprotected intercourse with 5 girls. Physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. Physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was
The article by Hogan et al 1 reporting the incidence of neutropenic colitis after induction with idarubicin and cytosine arabinoside is relevant to a recent interesting case at our institution. A 53-year-old woman presented to the emergency department because of intermittent severe abdominal pain of 3 days' duration. She described primarily right-sided abdominal pain with subjective fever and occasional loose stools. Physical examination was remarkable for fever and tenderness to palpation in the right upper and lower quadrants with accompanying peritoneal signs. A complete blood cell count revealed an elevated white blood cell count of 89.7 × 10 9 /L with absolute neutrophil count of 23.0 × 10 9 /L, hemoglobin value of 7.3 g/dL, and platelet count of 142 × 10 9 /L. Myelomonocytic blasts were present on the peripheral smear. Abdominal computed tomography revealed pericolonic stranding and mucosal thickening involving the cecum and proximal ascending colon. This presentation was consistent with typhlitis in the presence of underlying leukemia, confirmed as acute myelogenous leukemia French-American-British (FAB) type M4 on subsequent bone marrow biopsy. Although enterocolitis is a rare presenting complication of hematologic malignancies, it has been reported. 2,3 The patient was admitted and treated with broad-spectrum antibiotics, bowel rest, and hydration. Stool cultures were negative for enteric pathogens. After 3 days of antibiotic treatment, the patient's abdominal pain resolved completely. She was given idarubicin, 12 mg/m 2 , and cytosine arabinoside, 100 mg/m 2. On day 4 of induction, she developed right lower quadrant pain, fever, diarrhea, and tenesmus. The patient's absolute neutrophil count at that time was 0.6 × 10 9 /L. Repeated computed tomography of the abdomen revealed bowel wall thickening up to 1 cm involving the entire colon, consistent with a diagnosis of neutropenic enterocolitis. The patient was treated supportively with bowel rest, broad-spectrum antibiotics, hydration, and parenteral nutrition. After 15 days, the patient's neutropenia and abdominal pain resolved. Stool and blood cultures were negative during the period of neutropenia. This patient's presentation is intriguing because the original typhlitis was likely related both to the leukemia and an infectious process. This theory is supported by the patient's resolution of symptoms with supportive care and antibiotics. These factors leading to colitis were then likely
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