| Three Cases of Typhlitis during Treatment for Acute Myelocytic Leukemia in Children. |
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Soon Mee Park1, Il Soo Ha1, Hoan Jong Lee1, Jeong Kee Seo1, Hyo Seop Ahn1, Kyung Mo Yeon2 |
1Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
2Department of Radiology, College of Medicine, Seoul National University, Seoul, Korea |
| 소아의 급성 골수성 백혈병 치료중에 발생한
Typhlitis 3례
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박순미1, 하일수1, 이환종1, 서정기1, 안효섭1, 연경모2 |
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 방사선학과교실 |
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Received: 22 May 1989 • Accepted: 9 August 1989 |
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| Abstract |
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Typhlitis is a rare necrotizing colitis in which inflammation is confined to cecum. It occurs during
chemotherapy for malignancies, in terminal stage of aplastic anemia, in transplant patients. The
pathogenesis of typhlitis has included leukemic infiltration of the bowel, thrombocytopenia, direct
toxic effects of chemotherapy, steroid, bacterial invasion of the bowel wall secondary to neutropenia
and alteration of the bowel flora by broad-spectrum antibiotics. Typhlitis is an important complica-
tion to determine prognosis of leukemia which otherwise has increased remission rate and 5-year
survival rate. Clinically diagnosis of typhlitis is difficult because its symptoms and signs are not
specific. Acute appendicitis should be included in the differential diagnosis. Prognosis of typhlitis is
grave despite of medical treatment and surgical intervention. Therefore early suspicion, early
diagnosis, and early treatment are very important in leukemia which has chance of complete
remission. We report three cases of typhlitis in acute myelocytic leukemia.
In the first case, typhlitis occurred 7 days after starting induction chemotherapy (high-dose Ara-C).
Initial presentation of typhlitis was high fever which was followed by right lower-quadrant abdominal
pain and watery mucoid diarrhea 3 days later. The peripheral leucocyte count was 10Q/mm3. Typhlitis
was diagnosed by abdominal ultrasonography and small bowel study 5 days after high fever and
managed with agressive parenteral antibiotics. The patient was discharged with improvement of
symptoms 33 days after high fever. But the patient has been readmitted 4 times because of recurrent
high fever. In the 5th admission, the patient died of septic shock.
In the second case, typhlitis occurred 14 days after starting maintenance chemotherapy (A-Triple
V schedule). Initial presentation of typhlitis was high fever which was followed by watery mucoid
diarrhea and abdominal pain 4 days later. The peripheral leucocyte count was 600/mm3. The
peripheral blood test showed DIC. Typhlitis was diagnosed by abdominal ultrasonography 6 days
after high fever and managed with aggressive parenteral antibiotics and Foy. But blast cells appeared
in the peripheral blood and bleeding tendency increased. The patient was discharged on the 19th
hospital day against medical advice and expired 2 months later at home.
In the third case, typhlitis occurred 11 days after starting induction chemotherapy (Adr, Ara-C,
MTX). Initial presentation of typhlitis was high fever which was followed by right lower-quadrant
abdominal pain, vomiting, and diarrhea 2 days later. The peripheral leucocyte count was 1400/mm3.
Typhlitis was diagnosed by abdominal ultrasonography 2 days after high fever and managed with
aggressive parenteral antibiotics. The patient was discharged with improvement of symptoms and
has been followed up at OPD till now for 1 month in remission state. |
| Key Words:
Typhlitis, Acute myelocytic leukemia |
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