Typhlitis in childhood cancer

Authors

  • M. Beth McCarville M.D.,

    Corresponding author
    1. Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
    • Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105
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    • Fax: (901) 495-4398

  • C. Scott Adelman B.S.,

    1. Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Chenghong Li M.S.,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Xiaoping Xiong Ph.D.,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Wayne L. Furman M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Hematology-Oncology, College of Medicine, University of Tennessee, Memphis, Tennessee
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  • Bassem I. Razzouk M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Hematology-Oncology, College of Medicine, University of Tennessee, Memphis, Tennessee
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  • Ching-Hon Pui M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Hematology-Oncology, College of Medicine, University of Tennessee, Memphis, Tennessee
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    • C.-H. Pui is the American Cancer Society FM Kirby Clinical Research Professor.

  • John T. Sandlund M.D.

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Hematology-Oncology, College of Medicine, University of Tennessee, Memphis, Tennessee
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Abstract

BACKGROUND

Typhlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging (ultrasonography and computed tomography [CT] scans) variables related to the diagnosis, risk, and outcome of typhlitis.

METHODS

The authors reviewed the records of patients who had typhlitis (bowel wall thickness ≥ 0.3 cm plus clinical findings) during treatment at St. Jude Children's Research Hospital (Memphis, TN) between 1990 and 2001. They assessed whether duration of typhlitis was related to bowel wall thickness, extent of colonic involvement, ascites, demographics, primary diagnosis, symptoms of typhlitis, or duration of neutropenia. To identify risk factors for typhlitis, the authors compared the demographic data and previous drug therapy of 78 patients who had typhlitis and 1231 identically treated children who did not.

RESULTS

Of 3171 children, 83 (2.6%) developed typhlitis. Frequent symptoms were abdominal pain (91%), fever (84%), abdominal tenderness (82%), and diarrhea (72%). Twelve percent of the patients were not neutropenic. Duration of typhlitis was associated with bowel wall thickness measured by ultrasonography (n = 68; P = 0.05) but not CT scan (n = 48; P = 0.67) and was associated with duration of neutropenia (P = 0.02), fever (P = 0.01), and abdominal tenderness (P = 0.04). Age >16 years at cancer diagnosis was the only demographic factor associated with typhlitis (P = 0.03). Two patients died of typhlitis.

CONCLUSIONS

Ultrasonography was a useful imaging modality for children with suspected typhlitis. The classic triad of abdominal pain, fever, and neutropenia may be absent. The severity of typhlitis was related to the duration of neutropenia and the presence of fever or abdominal tenderness. Cancer 2005. © 2005 American Cancer Society.

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