Colonic carcinoma presenting as repeated episodes of enterobacter septicaemia during induction of remission in acute myeloblastic leukaemia

doi:10.1136/bmj.b4027

Published 2 November 2009, doi:10.1136/bmj.b4027
Cite this as: BMJ 2009;339:b4027

Practice

Lesson of the Week

Colonic carcinoma presenting as repeated episodes of enterobacter septicaemia during induction of remission in acute myeloblastic leukaemia

Bassam Odeh, associate specialist¹, David Bareford, consultant haematologist²

¹ Department of Haematology, City Hospital, Birmingham B18 7QH, ² Department of Haematology, Russells Hall Hospital, Dudley DY1 2HQ

Correspondence to: D Bareford, Department Haematology, Russells Hall Hospital, Dudley DY1 2HQ d.bareford@bham.ac.uk

During neutropenic episodes, recurrent septicaemia with gutbacteria should prompt suspicion of underlying gut pathology

The first 150 words of the full text of this article appear below.

Patients undergoing curative treatment for acute leukaemia receiveseveral cycles of combination chemotherapy using intravenouscytotoxic drugs given through central venous catheters. As aside effect, each period of treatment is followed by a pancytopenicphase lasting between two and four weeks, when haemoglobin,white cells, and platelets reach very low levels. During thisperiod transfusions of blood and platelets are needed. If thepatient becomes pyrexial (neutropenic fever) blood culturesare taken and broad spectrum antibiotics are started while awaitingspecific identification of the cultured organism and its sensitivityto antibiotics. Over the past two decades the most common organismsisolated have been Gram positive bacteria, often in relationto the use of central venous catheters.¹ Staphylococcus epidermidisis frequently isolated and responds to vancomycin or teicoplanin.Repeated isolation of Gram positive organisms in blood cultureoften leads to removal of the central line with resolution ofthe problem. . . . [Full text of this article]