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

Abstract

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.

Perianal sepsis in neutropaenic patients with haematological malignancies: the role of magnetic resonance imaging and surgery

“…Recurrence is a significant and common cause of morbidity from perianal sepsis in patients with haematological malignancy. Studies report a recurrence rate between 12% and 73.7% of any anorectal disease (including non‐infective conditions such as anal fissure, anal fistula and haemorrhoids) in this cohort of patients . The rates of recurrence and the resolution of perianal abscess are similar despite surgical or conservative management strategy .…”

“…Perianal sepsis, defined as infection in the perianal area with or without drainable collection, is a common complication in patients with haematological malignancy, with a reported incidence of up to 10% . The mortality rate due to perianal sepsis is high and is thought to be between 11% and 57% in patients with neutropaenia .…”

Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?

“…Incomplete drainage might lead to worsening of cellulitis and sepsis, abscess recurrence, and fistula formation [ 1 – 3 ]. In patients with neutropenia and hematological malignancies, surgical treatments tend to be avoided because of concerns about delayed wound healing, secondary infections, and bleeding risks [ 8 , 12 , 15 ].…”

“…The frequency of anorectal infections in patients with hematological malignancies, including leukemia, has been reported as 5% to 9% [ 7 – 12 ]. When febrile neutropenia develops in patients with hematological malignancies who suffer from anorectal infections, broad-spectrum antibiotic treatment must be immediately prescribed, with modifications made based on the site of the infection and the identified pathogens [ 13 ].…”

A Novel Severity Score Index for Febrile Neutropenic Patients with Colorectal Diseases

“…The mortality of patients with acute leukemia and anorectal disease varies from 45-78%, and this condition must be treated in-hospital [17, 19]. The literature on the subject is unclear in terms of which diseases benefit from surgical management and the optimal time to pursue this course of action [12, 20]. A correlation exists between the number of circulating granulocytes and the incidence of anorectal infection.…”