Elsevier

Leukemia Research

Volume 30, Issue 5, May 2006, Pages 521-528
Leukemia Research

Cholecystitis in neutropenic patients: Retrospective study and systematic review

https://doi.org/10.1016/j.leukres.2005.08.029Get rights and content

Abstract

Abdominal infections are life-threatening complications in neutropenic patients. Among these, neutropenic cholecystitis is relatively rare. Nevertheless, its actual relevance is only investigated by anecdotal reports. We present a consecutive retrospective series of nine patients over a 12-year period. We calculated a frequency of 0.4% among all neutropenic episodes in patients with acute leukemia or aggressive lymphoma undergoing myelosuppressive chemotherapy. Only three of these patients had gallstones. Four patients died during the course of cholecystitis but in none of them cholecystitis was the primary cause of death. Systematic review of the literature revealed 45 patients with neutropenic cholecystitis of whom 26.7% died.

Introduction

Abdominal infections are life-threatening complications in neutropenic patients. Patients with leukemia undergoing aggressive chemotherapy are most often affected [1]. It is a diagnostic challenge for the physician to dissect the cause of abdominal symptoms (infectious and non-infectious) in these patients. Neutropenic enterocolitis is the most important entity. Acute cholecystitis is much rarer in neutropenic patients, but several, mostly anecdotal reports, suggest that this infection is of relevance in neutropenia. However, a systematic analysis describing a larger cohort of patients is lacking. In the IDSA guidelines for the use of antimicrobial agents in neutropenic patients with cancer no specific treatment recommendation concerning neutropenic cholecystitis is provided [2]. A major portion of the afflicted neutropenic patients suffer from acalculous cholecystitis similar to other groups of patients with very severe underlying diseases and different from standard risk patients [3], [4]. This study provides the largest published case series concerning neutropenic cholecystitis combined with a systematic review of the literature. It summarizes the clinical picture, diagnostic procedures, therapy and prognosis in these patients.

Section snippets

Patients and methods

A retrospective analysis of patients with cholecystitis in neutropenia treated in the leukemia ward and the intensive care unit of our university medical center from April 1991 to December 2004 was performed. Over this 12-year period all 1607 courses of myelo-suppressive chemotherapy administered in patients with acute leukemia or aggressive lymphoma (courses of intensive chemotherapy with a duration of neutropenia of at least 5 days only) were screened. Parts of this observation period (April

Patients in Bonn

Nine episodes of cholecystitis in nine patients treated in the leukemia ward and the intensive care unit of our university medical center with acute leukemia or aggressive lymphoma (following high dose-chemotherapy) were identified within a period of 12 years and 8 months (Table 2). During this period 1849 admissions of patients with these underlying diseases were recorded and 1607 cycles of myelosuppressive chemotherapy with a duration of neutropenia of at least 5 days were administered to

Discussion

Abdominal infections are life-threatening complications for patients with profound neutropenia. Most cases have been reported in patients with acute leukemia following chemotherapy [1]. Neutropenic enterocolitis is the most important entity. Acute cholecystitis is interestingly uncommon in neutropenic patients, but several mostly anecdotal reports suggest that this infection is also of relevance in neutropenia.

Our study reveals several important results: (1) In our own patients a frequency of

Acknowledgments

This study was supported by Leukämie-Initiative Bonn e.V. The authors declare that they have no conflicts of interest.

Contributions. MG was responsible for the design and the statistical analysis of the project; MG and AG drafted the manuscript; MG, JS, MS and CL extracted and checked the data; UM and TS provided statistical and methodological input and contributed to the manuscript. All authors revised and approved the manuscript.

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