Anal lesions in hematologic diseases

Vanheuverzwyn, Robert; Delannoy, André; Michaux, Jl.; Dive, Caroline

doi:10.1007/bf02586835

Cited by 56 publications

(34 citation statements)

References 7 publications

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“…The reason for this difference is unclear, but the two main possibilities are either alterations in the host immune response or, alternatively, different micro-organisms opportunistically infecting the immunocompromised host and causing a different clinical phenotype. The former seems more likely, as results in microbiologic series (5,6,8,23) suggest that the pathogens isolated from patients with hematologic malignancies are gut commensals such as Enterobacteriaceae-no different from those in immunocompetent patients. Irrespective of the precise reason, MR imaging appearances clearly differ in patients with hematologic malignancies from those in control patients, and these imaging features do not mandate surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Perianal Sepsis in Hematologic Malignancy: MR Imaging Appearances and Distinction from Cryptoglandular Infection in Immunocompetent Patients

et al. 2015

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MRCP, FRCR Purpose:To use magnetic resonance (MR) imaging to document the appearance of perianal infection in patients with a hematologic malignancy (HM) compared with that in immunocompetent control patients. Materials and Methods:After an ethical waiver was obtained, 38 patients with an HM were matched by age and sex to 38 control patients with no history of immunocompromise or Crohn disease. Both groups had undergone MR imaging for perianal symptoms and/or systemic sepsis. Two radiologists who were blinded to the diagnosis independently reviewed the MR images and recorded the size and distribution of abscesses and/or fistula tracts, the extent of perianal edema, and the likely diagnosis. Groups were compared by using the Mann-Whitney-Wilcoxon, x 2 , or Fisher exact test. Receiver operating characteristic (ROC) curves were constructed to estimate the ability of MR imaging to help distinguish patients with an HM from control patients. Results:Patients with an HM had significantly greater perianal edema than did control patients (mean arc angle of anal canal involved, 220° vs 60°; P , .001). However, they had significantly lower rates of fistula (15 [ Conclusion:Perianal infection in patients with an HM is more likely to cause diffuse perianal edema and is less likely to cause fistulas than in immunocompetent patients. MR imaging can help distinguish patients with an HM from those without immunocompromise.q RSNA, 2015

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Section: Discussionmentioning

confidence: 99%

“…Perianal infection occurs in approximately 5%-10% of patients with acute leukemia (5)(6)(7)(8) and may occasionally be the presenting complaint (9). The underlying pathophysiology is believed to be no different from that in immunocompetent patients-that is, infection begins in the intersphincteric anal glands (10).…”

Section: Author Contributionsmentioning

confidence: 99%

Perianal Sepsis in Hematologic Malignancy: MR Imaging Appearances and Distinction from Cryptoglandular Infection in Immunocompetent Patients

et al. 2015

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“…Perianal or rectal abscesses are uncommon in immunocompetent subjects [2] but they may occasionally occur in leukemia or other neutropenic patients [2,7,8,9,10]. In patients with acute leukemia receiving chemotherapy, the incidence of perianal abscess is 5-9% [1,11,12,13]. …”

Section: Discussionmentioning

confidence: 99%

“…Surgical interventions should be advised in most immunocompetent patients with a perianal abscess [2,3,4]. Surgical treatment for leukemia patients with a perianal abscess has been reported [12,15,16]. However, due to the high risk of bleeding and subsequent infection, many patients are treated with antibiotics alone and favorable outcomes have been reported [5].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Recurrence Pattern of Perianal Abscess in Patients with Acute Myeloid Leukemia

Chang

Kuo²,

Tang³

et al. 2017

Acta Haematol

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Introduction: Perianal abscess may develop during neutropenia periods in patients with acute myeloid leukemia (AML). The standard of care for perianal abscess in AML is unclear. Methods: We retrospectively collected patient data in our institute from 2009 to 2012. Results: Two hundred ninety-two patients with AML were analyzed. In total, 1,051 chemotherapy sessions were administered. Twenty-three patients experienced perianal abscess. Patients with perianal abscess were younger than those without (44 vs. 60 years, p < 0.0001). Perianal abscess developed in various phases of treatment and in the stem cell transplantation period. Twelve recurrences developed in 6 patients. Patients with a prior perianal abscess have a 10-fold risk of developing a subsequent abscess following further chemotherapy. The microbiology profile revealed that most pathogens were derived from the intestinal tracts, which was similar to the findings of previous studies. The 28-day mortality was 14.3% and the direct cause of death was not perianal abscess in any case. Surgical interventions had no impact on recurrence or survival. Conclusion: In patients with AML, perianal abscess results from gastrointestinal tract pathogens. Many patients do not require surgical interventions. The mortality is low but recurrence is common following subsequent chemotherapies. Therefore, awareness of recurrence is important for the timely management of perianal abscess in AML.

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“…Previously, several clinical studies identified risk factors for anorectal infection in immunocompromised patients [3][4][5]. Generally, anorectal infections in immunocompromised patients can be successfully managed with antibiotic therapy and local care alone [2].…”

Section: Introductionmentioning

confidence: 99%

Successful Surgical Rescue of Hepatic Encephalopathy due to Anal Fissure in the Case of Acute Myeloid Leukemia

Nakamura

2012

J Med Cases

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Anal fissures and other anorectal complications are relatively common conditions, which are rarely fatal. However, it is important to understand that these conditions could progress to lethal infections in immunocompromised patients. On the other hand, Hepatic encephalopathy (also known as portosystemic encephalopathy) is a potentially-reversible, life-threatening, systemic, neuropsychiatric disorder, which occurs in the setting of liver failure. Hepatic encephalopathy can occur in either acute or chronic liver disease, or, in the case of portal-systemic shunting, without associated intrinsic liver disease. Hepatic encephalopathy due to anal fissure is relatively rare. In cases of perirectal cellulitis caused by Escherichia Coli (E. Coli) or other enteric bacteria large amounts of NH3 are produced, especially in immunocompromised patients. This NH3 is subsequently drained by the middle or lower rectal veins from the rectal venous plexus to the systemic circulation. Consequently, patients can experience severe hepatic encephalopathy in spite of normal liver function. To our knowledge, this is the first published case of an anal fissure presenting with hepatic encephalopathy during therapy-related neutropenia in a patient with AML. Surgical intervention with sigmoid colostomy and perirectal drainage is the procedure of choice to treat life-threatening hepatic encephalopathy in immunocompromised patients with anorectal cellulitis not responding to conservative therapy. For this reason, we also chose to perform a sigmoid colostomy with drainage of the perirectal cellulitis.

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Anal lesions in hematologic diseases

Cited by 56 publications

References 7 publications

Perianal Sepsis in Hematologic Malignancy: MR Imaging Appearances and Distinction from Cryptoglandular Infection in Immunocompetent Patients

Perianal Sepsis in Hematologic Malignancy: MR Imaging Appearances and Distinction from Cryptoglandular Infection in Immunocompetent Patients

Clinical Features and Recurrence Pattern of Perianal Abscess in Patients with Acute Myeloid Leukemia

Successful Surgical Rescue of Hepatic Encephalopathy due to Anal Fissure in the Case of Acute Myeloid Leukemia

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