Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review

Ali, Alaa; Alhindi, Saeed; Alalwan, Adel A

doi:10.7759/cureus.8858

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Initial empiric coverage for antifungal agents is not routinely recommended but they can be considered if the initial therapy does not show optimal response in 72 h[ 11 ]. Indications for surgery include bowel perforation, uncontrolled massive GI bleeding, abscess or appendicitis which occurs in 0.5%-1.5% of patients[ 11 , 19 ].…”

Section: Leukemias In Childrenmentioning

confidence: 99%

Gut and liver involvement in pediatric hematolymphoid malignancies

Devarapalli¹,

Sarma²,

Mathiyazhagan³

2022

WJGO

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Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.

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Section: Leukemias In Childrenmentioning

confidence: 99%

Gut and liver involvement in pediatric hematolymphoid malignancies

Devarapalli¹,

Sarma²,

Mathiyazhagan³

2022

WJGO

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mentioning

confidence: 99%

“…Delaying or stopping chemotherapy is controversial, especially in newly diagnosed patients with HOD. [3][4][5][6] We present three cases of children simultaneously diagnosed with acute lymphoblastic leukemia (ALL) and complicated appendicitis.They were managed with appendectomy, and less toxic chemotherapy consisted of L-asparaginase 6000 IU/m 2 and escalating doses of methotrexate (50-200 mg/m 2 ) in 10 days intervals 7 (Table 1).…”

mentioning

confidence: 99%

Escalated doses of methotrexate and L‐asparaginase in critically ill children with a concurrent diagnosis of acute lymphoblastic leukemia and appendicitis

Colunga‐Pedraza

Fierro-Saenz

Lopez-Reyna

et al. 2022

Pediatric Blood & Cancer

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Abdominal complications in pediatric patients with hemato-oncology diseases (HOD) often present with atypical symptoms, resulting in a diagnostic and therapeutic challenge. 1,2 There are no consensus guidelines for the optimal management of a child with neutropenic appendicitis. Delaying or stopping chemotherapy is controversial, especially in newly diagnosed patients with HOD. [3][4][5][6] We present three cases of children simultaneously diagnosed with acute lymphoblastic leukemia (ALL) and complicated appendicitis.They were managed with appendectomy, and less toxic chemotherapy consisted of L-asparaginase 6000 IU/m 2 and escalating doses of methotrexate (50-200 mg/m 2 ) in 10 days intervals 7 (Table 1).

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