Neutropenic Enterocolitis in the Treatment of Solid Tumors: A Case Report and Review of the Literature

Abstract

Neutropenic enterocolitis is a clinical condition characterized by inflammation of the colic mucosa, usually the caecum, associated with bowel wall thickening in patients with compromised immune system due to chemotherapy treatments. It can occur as well in other clinical conditions that lead to immunosuppression. Clinically, patients present with abdominal pain, fever, and neutropenia on blood tests. A number of major and minor criteria have been suggested for the clinical diagnosis of typhlitis. The most sensitive radiological investigation is represented by a computed tomography scan. There are no guidelines for treatment, but some factors may lead the clinician to medical treatments or prompt surgery as the best choice in that particular patient. The most implicated chemotherapeutic regimens are those based on taxanes. Here, we present a clinical case of a young patient with breast cancer and a review of the state of the art of knowledge regarding neutropenic enterocolitis in adult patients undergoing chemotherapy for the treatment of solid tumors.

Neutropenic Enterocolitis and Sepsis: Towards the Definition of a Pathologic Profile

“…Of those with a history of cancer and available clinical data, all had received chemotherapy in the previous month, particularly those agents that cause mucositis, such as taxanes [ 45 ].…”

“…Alterations were described in all segments of the GI including the ileus, left or right colon, or both, with involvement of different entities and considered mainly segmental or irregular (although diffuse or focal were also described) [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…In any case, the extrapolated data allowed us to conclude that the integration of medical history, clinical and laboratory data, radiological imaging, and macroscopic and histological investigations allowed us to identify a specific pathological profile. As regards the medical history, particular attention must be paid to subjects with onco-hematological neoplasia (in particular leukemia or solid tumors), in treatment with chemotherapeutic agents (among which particular attention must be paid to therapeutic schemes involving taxanes) [ 13 , 14 , 45 ]. An important clinical element is the triad composed of fever, abdominal pain, and diarrhea, but certainly the alarm bell is represented by marked neutropenia.…”

Neutropenic Enterocolitis: A Rare Complication of Sacituzumab Govitecan

“…It has been commonly reported in patients with hematologic malignancies and stem cell transplant patients receiving myeloablative chemotherapy regimens [ 9 ]. NE has also been associated with the use of cytotoxic chemotherapy for the treatment of solid tumors, particularly with the use of Taxane-based regimens (paclitaxel and docetaxel) [ 9 , 10 ]. We report a case of diagnosis and successful management of NE in a 57-year-old female patient with metastatic breast cancer receiving treatment with SG.…”