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Resident: Neutropenic Fever with Acute Diarrheal Illness
EP30876
Poster Title: Resident: Neutropenic Fever with Acute Diarrheal Illness
Submitted on 22 Oct 2019
Author(s): Juilett Kostanjevec, D.O. PGY 2; Nida Jiwani, D.O. PGY 1; Daniel Frilingos, M.D.; Amimi Osayande, M.D., FAAFP.
Affiliations: Northside Hospital
Poster Views: 201
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Poster Information
Abstract: Introduction:
Common Variable Immunodeficiency (CVID) is a form of severe antibody deficiency in which B cell differentiation is impaired and immunoglobulin production is defective, which predisposes patients with CVID to many illnesses. Neutropenic fever is defined as a temperature greater than 100.4 F in a person with a depressed neutrophil count, which may be seen in CVID. Infections in neutropenic patients can progress rapidly, leading to severe hypotension and even death without rapid initiation of antibiotic therapy.

Case:
We present a case of a 36-year-old male with a history of CVID and splenectomy who presented with fever, abdominal pain, and 5-6 episodes of diffuse watery diarrhea over the course of 48 hours. On admission our patient met septic criteria and was found to have neutropenic fever. CT of his abdomen and pelvis showed thickening of the right transverse and proximal descending colon consistent with colitis. He was started on pipercillin-tazobactam empirically for neutropenic fever. After several days, his stool cultures resulted in salmonella. He was then transitioned to appropriate antibiotic coverage with ciprofloxacin and ultimately had complete resolution of his symptoms. Colitis secondary to Salmonella would not typically require antibiotic therapy. However, antibiotic treatment may be warranted in immunocompromised patients, especially in the case of neutropenic fever complications.
Summary: Common Variable Immunodeficiency (CVID) is a form of severe antibody deficiency in which B cell differentiation is impaired and immunoglobulin production is defective, which predisposes patients with CVID to many illnesses. Neutropenic fever is defined as a temperature greater than 100.4 F in a person with a depressed neutrophil count, which may be seen in CVID.References: References
Alison G. Freifeld, Eric J. Bow, Kent A. Sepkowitz, Michael J. Boeckh, James I. Ito, Craig A. Mullen, Issam I. Raad, Kenneth V. Rolston, Jo-Anne H. Young, and John R. Wingard. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. 2010.
Wingard, John R. “Treatment of Neutropenic Fever Syndromes in Adults with Hematologic malignancies.” UpToDate. WoltersKlower. 11 Jun 2019. https://www.uptodate.com/contents/treatment-of-neutropenic-fever-syndromes-in-adults-with-hematologic-malignancies-and-hematopoietic-cell-transplant-recipients-high-risk-patients?search=neutropenic%20fever%20syndromes&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4
Hohmann, Elizabeth. “Non-typhoidal Salmonella: Gastrointestinal infection and carriage.” UpToDate, WoltersKlower. 07 January 2018. https://www.uptodate.com/contents/nontyphoidal-salmonella-gastroint
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