Perianal Infections as First Presentation of Hemoblastosis and Aplastic Anemia

Abstract

AIM: to present clinical variability of perianal infection (PI), developed in the debut of oncohematological disease and to determine the factors that impede PI relief and time of antitumor treatment initiation, as well as the causes of complications during chemotherapy (ChT).PATIENTS AND METHODS: the analysis included 8 patients with an infectious process in the perianal region developed in the debut of hemoblastosis and aplastic anemia (before ChT).RESULTS: in 5 of 8 patients there was a long time between start of PI and the start of ChT for hemoblastosis, from 18 to 49 days. The impediment for a favorable time to start ChT were not clarified diagnosis of hemoblastosis (acute myeloid leukemia – 2 cases, multiple myeloma – 1, lymphoma – 1) and the ongoing infectious process in patients with severe granulocytopenia (GCP). Usually undetected hematological malignancies were observed in patients with compensated data of haemogram. Complications during ChT were associated with recurrence of PI in the area of surgery (palliative drainage of anorectal abscess and fistula-in-ano) and of the sepsis with persisted inflammation in the postoperative wound on the background of GCP.CONCLUSION: PI is one of the infectious complications peculiar for the debut of oncohematological disease. Therefore, a general blood test with leukocyte formula should be performed before surgery in all patients with paraproctitis to exclude hemoblastosis. The unknown diagnosis of hemoblastosis and the ineffectiveness of surgical treatment of paraproctitis in patients with severe GCP were the main reasons for the delay in the beginning of antitumor treatment in this study. Persistent infection (fistula-in-ano) and the persistent inflammation in the wound on the background of the GCP has resulted in the recurrence of PI and sepsis during chemotherapy.

Perianal Infectious Complications in Patients With Granulocytopenia and Haematological Malignancies

“…В этой группе пациентов был возможен и пероральный прием препаратов. Среди факторов, влияющих на прогноз течения ПИ и стратегию антибактериальной терапии, большое значение имеет продолжительность периода ГЦП [7,17,18]. В нашем исследовании с увеличением срока ГЦП от 1-14 до 30 более дней связано увеличение частоты бактериемии (12,5% против 28% p<0,05); сочетания ПИ с другими инфекциями; необходимость модификации антибактериальной терапии (16,7% против 40% p<0,05); длительности применения антибиотиков (8,3 против 23,1 дня; p<0,05).…”