Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient

Warad, Deepti; Kohorst, Mira A.; Altaf, Sadaf; Ishitani, Michael B.; Khan, Shakila; Rodriguez, Vilmarie; Rao, Amulya A. Nageswara

doi:10.1016/j.lrr.2015.03.001

Cited by 3 publications

(3 citation statements)

References 16 publications

(20 reference statements)

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“…4 When leukaemia patients undergo transplantation, the risks of infection are much higher, especially during the neutropaenic phase. The occurrence rate was 1.29% (10/776 patients) in this study, which is below the incidence rate of 1.9% (3/154 patients), which was observed amongst 154 children in a study reported by Warad et al 5 In this study, the occurrence of appendicitis may be related to the following factors: (1) cell resources from an allogenic donor;…”

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confidence: 71%

“…In general, appendectomy seems to be a better choice of treatment for acute appendicitis. 5,[9][10][11] However, in the neutropaenic phase of HSCT, appendectomy is an extremely tough choice for surgeons and haematologists, 12 and none of the patients in such a condition were transferred to receive appendectomy. In this study, we showed that acute appendicitis that occurred in patients during the neutropaenic phase of HSCT could be resolved with internal methods that use a combination of different kinds of full dose broad-spectrum antibiotics, bowel rest and total parenteral nutrition.…”

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confidence: 99%

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Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China

Zhang

Zhou

Majaw

et al. 2018

Bone Marrow Transplant

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Appendicitis is a rare but life-threatening complication in patients undergoing haematopoietic stem cell transplantation (HSCT). Infectious complications arising from the gastrointestinal tract are common in immunocompromised patients with haematologic malignances. 1,2 Serious infection often occurs in neutropaenic patients, especially during HSCT. Acute appendicitis is frequently reported in leukaemia patients after chemotherapy but is rarely reported during HSCT. The Alvarado Scoring System (the MANTRELS acronym stands for 'Migration, Anorexia-acetone, Nausea-vomiting, Tenderness in right quadrant, Reboud pain, Elevation of temperature, Leukocytosis, Shif to the left'), which is shortened to ASS-MANTRELS, has been used to diagnose acute appendicitis. 3 However, acute appendicitis occurred in HSCT patients during the neutropaenic phase. The indexes of leukocytosis and shift to the left (LS) of the ASS-MANTRELS were not applicable to these patients. Therefore, a standard criterion applicable for such patients who underwent HSCT was set up. Here we report 10 cases of acute appendicitis, which were selected from 776 sequential HSCTs.

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confidence: 71%

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confidence: 99%

Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China

Zhang

Zhou

Majaw

et al. 2018

Bone Marrow Transplant

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“…The incidence of leukemic infiltration of the appendix is negligible as shown by others; none of the patients had leukemic infiltration of appendix in our cohort ( Table 3 ). 12 13 14 It is difficult to diagnose appendicitis in immune-compromised patients with leukemia due to the absence of typical signs and symptoms. 8 9 15 Timely diagnosis of appendicitis is key to improving overall survival in these children.…”

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confidence: 99%

Acute Appendicitis in Children with Hematological Malignancies: The Need for Early Diagnosis and Prompt Treatment—A Single-Center Case Series

Kakkar,

Jain,

Jain

et al. 2024

Indian J Med Paediatr Oncol

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Introduction Appendicitis in patients with hematological malignancies presents with vague symptoms, thus requiring a high degree of suspicion for early diagnosis and treatment to prevent complications. Objectives The aim of this article was to describe the demographic, clinicoradiological, operative findings, and outcomes in patients with acute appendicitis with underlying hematological malignancies. Materials and Methods A retrospective review of pediatric patients with hematological malignancy who developed acute appendicitis was conducted. Medical records of patients were reviewed for patient demographics, disease status, signs, and symptoms at the time of diagnosis of acute appendicitis, and outcome. The laboratory, radiological, and histological findings were retrieved from the hospital records. Results Six (2.4%) patients developed acute appendicitis over the past 8 years among a total of 254 patients treated for hematological malignancies in the unit. Five patients had underlying acute lymphoblastic leukemia (ALL) and one had acute myeloid leukemia (AML). Of the five patients, three were in postremission consolidation, one each in the delayed intensification and maintenance phase of chemotherapy. The child with AML was on induction chemotherapy for the first relapse at the time of diagnosis. Fever and abdominal pain were the common presenting symptoms. Diagnosis was made on ultrasound abdomen in five patients, and one patient was diagnosed on computed tomography. All patients underwent open appendectomy. Two patients had evidence of appendiceal perforation. Three patients had neutropenia at the time of developing appendicitis and underwent appendectomy regardless of the absolute neutrophil count (ANC). Five patients recovered well, and chemotherapy was restarted within 2 weeks of appendectomy. One patient developed a superficial surgical site infection. and one patient with relapsed AML expired due to refractory septic shock. Conclusion Acute appendicitis in patients with hematological malignancies can present with subtle signs and symptoms. Appendectomy can be safely performed irrespective of the ANC.

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Unexpected diagnosis of appendicitis in a paediatric patient with febrile neutropaenia and acute myeloid leukaemia

Killian-Benigno

Kuo

2017

BMJ Case Reports

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DescriptionA 3-year-old boy with M7 acute myeloid leukaemia was admitted for induction chemotherapy with cytarabine, daunorubicin and etoposide. Two days later, he developed febrile neutropaenia and was started on cefepime. Blood cultures showed no growth and the fevers abated. Three weeks later, while still neutropaenic and receiving cefepime, the fevers recurred and persisted for 3 days with a maximum fever of 39.8° C. Antibiotics were changed to vancomycin and meropenem. He was non-toxic appearing without localising symptoms. He had occasional decreased appetite and loose stools, but he did not have abdominal pain, tenderness, masses or vomiting.Due to the persistent fevers, a CT scan of the chest, abdomen and pelvis was ordered which showed an acute appendicitis with abscess formation (figure 1). Appendectomy demonstrated acute necrotising appendicitis on pathological review without evidence of leukaemic involvement. He recovered well and became afebrile. Eight days later, fevers without abdominal symptoms recurred. Repeat CT scanning showed a large abscess in the right lower quadrant (figure 2). This was subsequently drained and cultures grew Pseudomonas. He received cefepime, metronidazole, tobramycin and filgrastim and subsequently recovered. He was discharged home when his neutrophil counts recovered 11 days later.The images shown demonstrate how large intra-abdominal processes can hide in the patient with neutropaenia. Due to the neutropaenia and lack of inflammatory immune responses, typical peritoneal signs were absent. His benign abdominal examination and continued oral intake were not suggestive of an intra-abdominal process at either time point, and without timely imaging, these infections could have progressed. Learning points► Intra-abdominal processes such as typhilitis, enterocolitis and appendicitis can be lifethreatening complications in patients with neutropaenia necessitating early diagnosis and intervention.1 2 ► In a patient with neutropaenia, such as one receiving intensive chemotherapy for leukaemia, persistent fevers despite broadspectrum intravenous antibiotic administration can warrant imaging, particularly of the abdomen and pelvis, because prolonged neutropaenia can mask the localising signs of infection by decreasing the inflammation that produces pain. In this case, dramatic imaging findings were found despite minimal abdominal symptoms.

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Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient

Cited by 3 publications

References 16 publications

Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China

Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China

Acute Appendicitis in Children with Hematological Malignancies: The Need for Early Diagnosis and Prompt Treatment—A Single-Center Case Series

Unexpected diagnosis of appendicitis in a paediatric patient with febrile neutropaenia and acute myeloid leukaemia

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