(in a 76-year-old Caucasian man with non-Hodgkin’s lymphoma. to those currently
April 8, 2017
(in a 76-year-old Caucasian man with non-Hodgkin’s lymphoma. to those currently indicated in the guidelines for cancer-related infections supporting the use of cephalosporins as Rucaparib monotherapy. represents one of the most common worldwide causes of bacterial gastroenteritis with over 190 0 cases occurring annually in the 27 member states of the European Union (www.efsa.europa.eu/efsajournal). Clinical manifestations include abdominal pain fever and diarrhea . Unlike other enteric infections is only rarely associated with extraintestinal localization and systemic invasive illness [1 2 Bacteremia caused by has been detected in less than 1% of patients with gastroenteritis and it has been mainly reported in elderly and in immunocompromised patients [1 2 In this study we describe a case of sepsis in a patient with non-Hodgkin’s lymphoma that resulted in a fatal outcome. The low incidence of bacteremia and the paucity of associated symptoms make this infection difficult to detect in patients with hematological disorders where selecting the appropriate antibiotic treatment is crucial and at present early and distinctive clinical features have not yet been fully elucidated. 2 Case Presentation A 76-year-old man was hospitalized in our Department of Hematology of the “Regina Elena” National Cancer Institute in Rome on 13 March 2014 He suffered from a Diffuse Large B-Cell Lymphoma that had evolved from a previously diagnosed indolent non-Hodgkin Lymphoma (NHL) which was refractory to three chemo-immunotherapeutic lines of treatment and was characterized by cerebral and meningeal involvement at the time of last progression. Upon admission the patient had evening fever and severe dysarthria (Figure 1). On March 14 he received an urgent salvage treatment based on a chemo-immunotherapeutic regimen containing Rituximab 375 mg/m2 on day 1 Methotrexate 1 g/m2 on day 2 and Cytarabine 1 g total dose twice daily for days 3 and 4. Given the presence of evening fevers and a moderate increase in procalcitonin levels (mini VIDAS system bioMérieux Florence Italy) to Rucaparib 2.62 ng/mL (normal <0.5 ng/mL) an empirical antibiotic therapy was administered including Ceftriaxone (2 g daily) at the beginning of the salvage chemo-immunotherapy even in the absence Rucaparib of any microbiological evidence from the blood cultures and surveillance swabs. After 48 h a complete regression of fever and a decrease in procalcitonin levels to 1 1.69 ng/mL were observed. Serial blood cultures taken on March 18 were incubated in an automated noninvasive culture system (BacT/ALERT bioMérieux Florence Italy). Figure 1 The patient’s clinical course. Procalcitonin (PCT-Q) levels were expressed as ng/mL. Antimicrobial susceptibility testing (AST) was performed by Etest? according to the Clinical and Laboratory Standards Institute (CLSI) breakpoints for ... On March 19 the hemocytometric assessment showed severe neutropenia and Rucaparib thrombocytopenia Rucaparib (hemoglobin 75 g/liter platelet count 6 × 109/liter white blood cell count 0.06 × 109/liter). On March 20 the stool culture exam gave negative results. Nevertheless on March 21 the patient had a relapse (fever > 39 °C) in the absence of symptoms indicating hemodynamic instability as well as abdominal pain or diarrhea. Based on the assumption that the patient was undergoing a sepsis the patient was empirically treated with intravenous Nkx2-1 Piperacillin-Tazobactam (4.5 g three times a day) without clinical improvement. The abdominal echography revealed a severe circumferential thickening of the cecum wall with Rucaparib submucosal edema whereas procalcitonin levels increased to 3.64 ng/mL. Meanwhile on March 22 the blood cultures were positive revealing curved gram-negative rods at the microscopic analysis. The organism was subcultured onto chocolate agar (bioMérieux Florence Italy) and then incubated at 36 °C in a microaerophilic environment with 5% CO2. Thus on March 23 based on the abdominal echography (suggestive for ileotiphlitis) and the patient’s general clinical conditions and increased procalcitonin levels even in the absence of.