Neutropenic Enterocolitis: A New Complication of Head and Neck Cancer Chemotherapy

Abstract

Neutropenic enterocolitis is a recognized complication of immunosuppression or chemotherapy for leukemia. It presents as severe abdominal pain and tenderness, fever, and diarrhea associated with granulocytopenia. Gastrointestinal symptoms associated with chemotherapy for head and neck neoplasms include nausea and emesis, but not acute abdominal distress. We present, to our knowledge, the first case of neutropenic enterocolitis in a patient receiving cisplatin and fluorouracil chemotherapy for metastatic head and neck cancer.

Neutropenic Enterocolitis in a Woman Treated with 5-Fluorouracil and Leucovorin for Colon Carcinoma

“…15 However, two cases of neutropenic enterocolitis have been associated with 5-fluorouracil treatment; one in a patient with laryngeal carcinoma who received 5-fluorouracil and cisplatin, and the other in a patient with colorectal carcinoma who received 5-fluorouracil and leucovorin. 15,25 We describe here another typical case, with a good outcome.…”

Severe Colitis Caused by Hepatic Arterial Infusion Chemotherapy with Cisplatin for Hepatocellular Carcinoma

“…The most common adverse effects of cisplatin used for HAIC are renal toxicity and cy-topenia (15,16). Although general chemotherapy with cisplatin is known to occasionally cause colitis (particularly neutropenic colitis) (6,8), no report has described colitis secondary to HAIC with cisplatin because the dosage of cisplatin used for HAIC is relatively small. Chemotherapy-induced gastrointestinal is a common complication observed in patients with cancer.…”

“…Neutropenic enterocolitis, ischemic colitis, and pseudomembranous colitis are the specific types of colitis that occur as adverse effects of chemotherapy. Neutropenic colitis occurs in any patient with significant neutropenia, which commonly occurs during the third week after receiving cytotoxic chemotherapy (6,8,17). Ischemic colitis has been reported with the administration of docetaxel-or gemcitabine-containing regimens, which manifests as blood-stained stool and intestinal necrosis on a colonoscopic examination (3)(4)(5).…”

Neutropenic enterocolitis as a complication of high dose chemotherapy with stem cell rescue in patients with solid tumors

“…Neutropenic enterocolitis is seen predominantly in the setting of advanced hematologic malignancies, but also has been found in patients with solid tumors treated with combination chemotherapy, in patients who are immunosuppressed due to organ transplantation, in patients with human immunodeficiency virus, and in patients with drug‐induced granulocytopenia 18‐24. Its reported incidence has varied and is dependent on whether clinical signs or pathologic findings at autopsy were used as criteria for diagnosis.…”

“…The management of neutropenic enterocolitis is controversial. Treatment approaches have been derived from small case studies and recommendations have ranged from conservative management with supportive care to immediate surgical intervention 3‐20, 21, 35‐37. Institution of broad‐spectrum antibiotics as well as supportive care measures has resulted in survivors with medical management alone.…”