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Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?

Patient: Male, 56-year-old Final Diagnosis: Perianal abscess Symptoms: Fever • gluteal pain • septic shock Medication: — Clinical Procedure: Debridement • fistulotomy • incision and drainage Specialty: Hematology • Infectious Diseases • Surgery OBJECTIVE: Rare disease BACKGROUND: Anorectal infection...

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Autores principales: Ohzu, Masami, Takazawa, Hitomi, Furukawa, Satomi, Komeno, Yukiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274364/
https://www.ncbi.nlm.nih.gov/pubmed/34218249
http://dx.doi.org/10.12659/AJCR.931589
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author Ohzu, Masami
Takazawa, Hitomi
Furukawa, Satomi
Komeno, Yukiko
author_facet Ohzu, Masami
Takazawa, Hitomi
Furukawa, Satomi
Komeno, Yukiko
author_sort Ohzu, Masami
collection PubMed
description Patient: Male, 56-year-old Final Diagnosis: Perianal abscess Symptoms: Fever • gluteal pain • septic shock Medication: — Clinical Procedure: Debridement • fistulotomy • incision and drainage Specialty: Hematology • Infectious Diseases • Surgery OBJECTIVE: Rare disease BACKGROUND: Anorectal infections occur in 5% to 9% of patients with hematological malignancies, including acute myeloid leukemia, and cause febrile neutropenia and sepsis. Surgical treatments of anorectal abscesses tend to be avoided in patients with leukemia owing to persistent neutropenia and bleeding risks. CASE REPORT: A 56-year-old man presented with an ischiorectal abscess. Preoperative laboratory test results revealed leukocytopenia and anemia. He was diagnosed with acute myeloid leukemia. He developed septic shock. Antibiotic treatment was ineffective, and fever persisted. One week later, the abscess was treated by incision and drainage. Two days later, induction chemotherapy was initiated. No pus was drained; cellulitis spread to both buttocks. Pain worsened, and oxycodone was administered. Achievement of complete remission failed. Reinduction therapy was started, followed by fistulotomy of the abscess with extensive debridement of cellulitis on day 6. Granulation was observed on day 17. The patient’s fever resolved on day 21. Although hematopoietic recovery was observed, bone marrow examination demonstrated partial remission. Two additional courses of chemo-therapy were administered. Abscess recurrence was not observed, even during febrile neutropenia. The surgical wound shrank to a skin defect along the gluteal cleft. He achieved complete remission and was transferred to another hospital, where he underwent 3 allogeneic stem cell transplants. He died of leukemia progression. CONCLUSIONS: Surgical treatments can prevent fatal progression of anorectal abscess, even during neutropenia. Incision and drainage are suitable for fluctuant abscesses. For a non-fluctuant abscess aggravated by sepsis and cellulitis, it is worth considering more invasive surgical interventions, including debridement and fistulotomy.
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spelling pubmed-82743642021-07-26 Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate? Ohzu, Masami Takazawa, Hitomi Furukawa, Satomi Komeno, Yukiko Am J Case Rep Articles Patient: Male, 56-year-old Final Diagnosis: Perianal abscess Symptoms: Fever • gluteal pain • septic shock Medication: — Clinical Procedure: Debridement • fistulotomy • incision and drainage Specialty: Hematology • Infectious Diseases • Surgery OBJECTIVE: Rare disease BACKGROUND: Anorectal infections occur in 5% to 9% of patients with hematological malignancies, including acute myeloid leukemia, and cause febrile neutropenia and sepsis. Surgical treatments of anorectal abscesses tend to be avoided in patients with leukemia owing to persistent neutropenia and bleeding risks. CASE REPORT: A 56-year-old man presented with an ischiorectal abscess. Preoperative laboratory test results revealed leukocytopenia and anemia. He was diagnosed with acute myeloid leukemia. He developed septic shock. Antibiotic treatment was ineffective, and fever persisted. One week later, the abscess was treated by incision and drainage. Two days later, induction chemotherapy was initiated. No pus was drained; cellulitis spread to both buttocks. Pain worsened, and oxycodone was administered. Achievement of complete remission failed. Reinduction therapy was started, followed by fistulotomy of the abscess with extensive debridement of cellulitis on day 6. Granulation was observed on day 17. The patient’s fever resolved on day 21. Although hematopoietic recovery was observed, bone marrow examination demonstrated partial remission. Two additional courses of chemo-therapy were administered. Abscess recurrence was not observed, even during febrile neutropenia. The surgical wound shrank to a skin defect along the gluteal cleft. He achieved complete remission and was transferred to another hospital, where he underwent 3 allogeneic stem cell transplants. He died of leukemia progression. CONCLUSIONS: Surgical treatments can prevent fatal progression of anorectal abscess, even during neutropenia. Incision and drainage are suitable for fluctuant abscesses. For a non-fluctuant abscess aggravated by sepsis and cellulitis, it is worth considering more invasive surgical interventions, including debridement and fistulotomy. International Scientific Literature, Inc. 2021-07-04 /pmc/articles/PMC8274364/ /pubmed/34218249 http://dx.doi.org/10.12659/AJCR.931589 Text en © Am J Case Rep, 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Ohzu, Masami
Takazawa, Hitomi
Furukawa, Satomi
Komeno, Yukiko
Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
title Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
title_full Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
title_fullStr Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
title_full_unstemmed Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
title_short Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate?
title_sort anorectal abscess in a patient with neutropenia and refractory acute myeloid leukemia: to operate or not to operate?
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274364/
https://www.ncbi.nlm.nih.gov/pubmed/34218249
http://dx.doi.org/10.12659/AJCR.931589
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