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

21 Citations (Scopus)

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

Fingerprint

Neutropenic Enterocolitis
Cecum
Appendicitis
Graft vs Host Disease
Histology
Colon
Drug Therapy
Colitis
Neutropenia
Immunosuppression

Keywords

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

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Sachak, T., Arnold, M. A., Naini, B. V., Graham, R. P., Shah, S. S., Cruise, M., ... Arnold, C. A. (2015). Neutropenic enterocolitis. American Journal of Surgical Pathology, 39(12), 1635-1642. https://doi.org/10.1097/PAS.0000000000000517

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

In: American Journal of Surgical Pathology, Vol. 39, No. 12, 01.12.2015, p. 1635-1642.

Research output: Contribution to journalArticle

Sachak, T, Arnold, MA, Naini, BV, Graham, RP, Shah, SS, Cruise, M, Park, JY, Clark, L, Lamps, L, Frankel, WL, Theodoropoulos, N & Arnold, CA 2015, 'Neutropenic enterocolitis', American Journal of Surgical Pathology, vol. 39, no. 12, pp. 1635-1642. https://doi.org/10.1097/PAS.0000000000000517
Sachak T, Arnold MA, Naini BV, Graham RP, Shah SS, Cruise M et al. Neutropenic enterocolitis. American Journal of Surgical Pathology. 2015 Dec 1;39(12):1635-1642. https://doi.org/10.1097/PAS.0000000000000517
Sachak, Taha ; Arnold, Michael A. ; Naini, Bita V. ; Graham, Rondell P. ; Shah, Sejal S. ; Cruise, Michael ; Park, Jason Y. ; Clark, Lindsey ; Lamps, Laura ; Frankel, Wendy L. ; Theodoropoulos, Nicole ; Arnold, Christina A. / Neutropenic enterocolitis. In: American Journal of Surgical Pathology. 2015 ; Vol. 39, No. 12. pp. 1635-1642.
@article{16578399c4f5446cbff180a627d4183e,
title = "Neutropenic enterocolitis",
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.",
keywords = "bacteria, chemotherapy, fungi, immunosuppressed, neutropenic enterocolitis (NE)",
author = "Taha Sachak and Arnold, {Michael A.} and Naini, {Bita V.} and Graham, {Rondell P.} and Shah, {Sejal S.} and Michael Cruise and Park, {Jason Y.} and Lindsey Clark and Laura Lamps and Frankel, {Wendy L.} and Nicole Theodoropoulos and Arnold, {Christina A.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1097/PAS.0000000000000517",
language = "English (US)",
volume = "39",
pages = "1635--1642",
journal = "American Journal of Surgical Pathology",
issn = "0147-5185",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Neutropenic enterocolitis

AU - Sachak, Taha

AU - Arnold, Michael A.

AU - Naini, Bita V.

AU - Graham, Rondell P.

AU - Shah, Sejal S.

AU - Cruise, Michael

AU - Park, Jason Y.

AU - Clark, Lindsey

AU - Lamps, Laura

AU - Frankel, Wendy L.

AU - Theodoropoulos, Nicole

AU - Arnold, Christina A.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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.

AB - 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.

KW - bacteria

KW - chemotherapy

KW - fungi

KW - immunosuppressed

KW - neutropenic enterocolitis (NE)

UR - http://www.scopus.com/inward/record.url?scp=84948713481&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84948713481&partnerID=8YFLogxK

U2 - 10.1097/PAS.0000000000000517

DO - 10.1097/PAS.0000000000000517

M3 - Article

C2 - 26414225

AN - SCOPUS:84948713481

VL - 39

SP - 1635

EP - 1642

JO - American Journal of Surgical Pathology

JF - American Journal of Surgical Pathology

SN - 0147-5185

IS - 12

ER -