Passage of intestinal (small bowel) cast - an unusual complication of neutropenic sepsis

Abstract

A 52-year-old woman was admitted with neutropenic sepsis, 3 days following the final cycle of adjuvant chemotherapy for breast cancer. Her condition deteriorated with progressive abdominal distension, bilious vomiting and diarrhoea. Abdominal examination revealed a mild degree of peritonism. Five days later she passed a small bowel cast per rectum, showing gross fungal contamination on histology. She was managed conservatively with antibiotics and antifungal medications and nutritional support. BACKGROUND

Apoptotic colopathy in a pediatric autologous bone marrow transplantation patient with spontaneous colonic cast excretion: Is it due to GVHD or rotavirus infection?

“…Similarly, Samee et al reported a neutropenic adult patient with enteropathy and sepsis presenting with the excretion of intestinal casts. The casts contained numerous fungal elements that pointed out a fungal infection [1].…”

“…Passage of intestinal casts per anus is an extremely rare entity. Severe ischemia, inflammation, bacterial and viral infections, and graft-versus-host disease are the etiological factors reported in the literature [1,2]. Apoptotic bodies in crypt epithelium may be a sign of ischemic crypt damage, viral infections (mostly CMV), chemotherapy, and/or radiation exposure.…”

Passage of intestinal casts—An unusual presentation of Cytomegalovirus enterocolitis

“…Intestinal cast, a spontaneously excreted, full-thickness, infarcted bowel segment, is an extremely rare condition. The majority of previously reported cases were spontaneous per anal passage of colonic cast and, more rarely, small intestinal cast [ [1] , [2] , [3] ]. A spontaneous excretion of small intestinal cast per oral has never been reported.…”

Per‐rectal passage of intestinal cast: an unusual complication of pseudomembranous enterocolitis in an immunocompromised patient and literature review

“…There are only a few aetiologies reported, such as ischaemic colitis 4 and in immunocompromised states as in graftversus-host disease 5 and neutropenic sepsis. 5 As highlighted in this case, the patient was immunocompromised due to the underlying active retroviral infection, complicated by CDI, gastrointestinal CMV infection and also Candida infection leading to the development of this complication.…”

“…Serological markers are somewhat useful with schistosome antigen serology, 6-12 weeks after the acute infection, often used for patients with low parasite burden in the acute phase or negative stool samples but with high suspicion of disease. 5 Colonoscopy is another diagnostic option, which can show oedematous changes, yellowish schistosomal nodules similar to those found in pseudomembranous colitis or granulomatous polyps secondary to schistosomal eggs becoming embedded in the submucosa causing an inflammatory response. 6…”