All issues > Volume 32(10); 1989

Original Article

J Korean Pediatr Soc. 1989;32(10):1455-1462. Published online October 31, 1989.

Three Cases of Typhlitis during Treatment for Acute Myelocytic Leukemia in Children.

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

Received: May 22, 1989;  Accepted: August 9, 1989.

Abstract

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.

Keywords :Typhlitis, Acute myelocytic leukemia