Study on Confirmed Case of Neutropenic Enterocolitis in Armenia

Neutropenic enterocolitis (NE) also known as typhlitis is a severe condition usually affecting immunocompromised patients. This is a first documented case of NE in Armenia. 12-years old girl who was diagnosed with Hodgkin Lymphoma IIA in September of 2019 was hospitalized and chemotherapy was initiated with prednisolone, vincristine, doxorubicin and etoposide. On the 9th day of chemotherapy she had abdominal pain, cramps, constipation. Laboratory findings were unremarkable. Empiric Helicobacter Pylori (HP) eradication was prescribed (regimen with amoxicillin and clarithromycin) by gastroenterologist. 2 days later she had fever and CBC showed profound neutropenia (WBC -0.34 neutrophil counts 0.06*103/ L). Meropenem was started for febrile neutropenia. Despite the treatment symptoms were persistent. Based on the symptoms (fever, neutropenia, abdominal pain, diarrhea) NE was suspected and CT scan of abdomen was performed. It revealed the width of the intestinal mucosa 0.5-1.0 cm. Consequently, the diagnosis of NE was confirmed and clarithromycin was switched to metronidazole accordingly. Pseudomonas aeruginosa was detected in blood culture and Proteus vulgaris was detected in stool culture. After 10 days of antibacterial therapy and diet the patient was recovered. CONCLUSION: Awareness of typhlitis and possible risk factors at local institutions might help to modify the incidence and consequences of typhlitis.