Neutropenic enterocolitis

Taha Sachak, Michael A. Arnold, Bita V. Naini, Rondell P. Graham, Sejal S. Shah, Michael Cruise, Jason Y. Park, Lindsey Clark, Laura Lamps, Wendy L. Frankel, Nicole Theodoropoulos, Christina A. Arnold

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Neutropenic enterocolitis (NE) is a deadly ileocecal-based disease seen in patients with a recent history of chemotherapy. As histology is not included in the current diagnostic criteria, the pathologic features of NE are poorly understood. We undertook a multi-institutional study of NE, and report helpful clinical clues, such as immunosuppression (n=20/20), recent chemotherapy (n=17/18), neutropenia (n=16/18) gastrointestinal symptoms (n=19/19), abnormal imaging studies of the cecum/right colon (n=11/14), and positive microbiological studies (n=13/15). Fever (n=9/15) and sepsis (n=8/16) were also common. Pathologically, the cecum/right colon was always involved (n=17/17), but findings were identified in other bowel segments as well. NE lesions consisted of patchy necrosis (n=18/20), infiltrating organisms (n=17/20), hemorrhage (n=15/20), ulcer (n=15/19), edema (n=15/20), and depletion of inflammatory cells (n=15/20). Seventy-nine percent (n=15/19) of patients with histologically confirmed NE died: 47% (n=7/15) of these deaths were attributed to NE and the remainder to the patients' underlying conditions. Importantly, we observed a clinical diagnostic discordancy rate of 35% (n=9/26): 15% (n=3/20) of histologically confirmed NE were clinically unsuspected, and 26% (n=6/23) of clinically suspected NE represented a different disease process. Alternative diagnoses included unspecified colitis, infection, graft-versus-host disease, relapsed malignancy, mycophenolate injury, appendicitis, and ischemia. The causes of death in patients with NE mimics included unrecognized appendicitis and unrecognized graft-versus-host disease. To improve diagnostic accuracy, we propose that histology be required for a diagnosis of "definitive NE," with other clinically suspicious cases reported as "suspicious for NE" until all other possible diagnoses have been reasonably excluded.

Original languageEnglish (US)
Pages (from-to)1635-1642
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume39
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • bacteria
  • chemotherapy
  • fungi
  • immunosuppressed
  • neutropenic enterocolitis (NE)

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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    Sachak, T., Arnold, M. A., Naini, B. V., Graham, R. P., Shah, S. S., Cruise, M., Park, J. Y., Clark, L., Lamps, L., Frankel, W. L., Theodoropoulos, N., & Arnold, C. A. (2015). Neutropenic enterocolitis. American Journal of Surgical Pathology, 39(12), 1635-1642. https://doi.org/10.1097/PAS.0000000000000517