A patient with neutropenic fever and abdominal pain showing absent bowel wall on CT

Abstract

A 35-year-old Asian female with acute myeloblastic leukaemia developed fever and right lower abdominal pain 6 days after second induction chemotherapy. The white blood cell count was 10 ml 21 with 0% neutrophils. Peripheral blood culture was negative for aerobic and anaerobic organisms. Haematologists changed the antibiotics and started amphotericin B on the presumptive diagnosis of typhlitis. However, 13 days later, the patient again complained of severe abdominal pain. An urgent contrast enhanced abdominal CT was performed.CT showed a long segmental wall thickening of the terminal ileum, caecum and ascending colon with targetlike appearance. A relatively long segment of posteromedial wall of the ascending colon was not visualised, in association with a small amount of concentrated air bubbles close to the bowel wall, regional mesenteric haziness and a large amount of loculated fluid collected along the right psoas muscle (Figure 1-4).What is the cause of these imaging findings?

Gastrointestinal mucormycosis in immunocompromised hosts

“…After review of our institutional cases and the published literature, four institutional and 27 literature cases met the inclusion criteria . Clinical presentation, management and outcomes for these cases are summarised in Table .…”

Gastrointestinal Mucormycosis following aStreptococcus pyogenesToxic Shock Syndrome in a Previously Healthy Patient: A Case Report

“…Angioinvasion and hematogenous dissemination to other organs are the hallmarks of mucormycosis. Gl mucormycosis is the rarest form and involves mainly the stomach, the colon, and the small bowel [ 6 ]. The fungus invades the bowel wall and blood vessels, leading to bowel ischemia, necrosis, perforation, peritonitis, or massive hemorrhage [ 5 , 7 – 9 ].…”

“…Because of its vascular tropism, rapid diagnosis of mucormycosis is essential to lower mortality [ 7 ], which can be higher than 50% in patients with hematological malignancies [ 6 ]. Unfortunately, diagnosis is difficult and requires a biopsy of the organ(s) involved.…”

Gastrointestinal Mucormycosis Requiring Surgery in Adults with Hematologic Malignant Tumors: Literature Review

“…In this review, the ileo-cecal region was the most common GI site affected. This location in patients with hematologic malignant disease presents a clinical challenge for surgeons as typhilitis and early mucormycosis appear similar radiographically [28,29]. If hemodynamically stable neutropenic patients present with abdominal pain and CT findings consistent with typhilitis, surgery is deferred typically unless perforation, obstruction, or uncontrollable GI bleeding is present.…”