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Case Reports
. 2018 Dec 15;57(24):3667-3671.
doi: 10.2169/internalmedicine.1227-18. Epub 2018 Aug 10.

Fatal Neutropenic Enterocolitis Caused by Stenotrophomonas maltophilia: A Rare and Underrecognized Entity

Satoshi Kaito  1   2 , Noritaka Sekiya  2   3 , Yuho Najima  1 , Naoki Sano  4 , Shinichiro Horiguchi  4 , Kazuhiko Kakihana  1 , Tsunekazu Hishima  4 , Kazuteru Ohashi  1
Affiliations
Case Reports

Fatal Neutropenic Enterocolitis Caused by Stenotrophomonas maltophilia: A Rare and Underrecognized Entity

Satoshi Kaito et al. Intern Med. .

Abstract

Although Stenotrophomonas maltophilia causes substantial morbidity and mortality in immunocompromised patients, it has not been described as a causal pathogen of neutropenic enterocolitis (NEC). We describe the first case of histologically-confirmed NEC caused by S. maltophilia accompanied by bacteremia and pneumonia after salvage chemotherapy for acute myeloid leukemia relapse following a second hematopoietic stem cell transplantation. S. maltophilia should be included as a pathogenic organism of NEC in severely immunocompromised patients to prevent a delayed diagnosis, which carries a high risk of inappropriate antimicrobial selection and fatal outcome.

Keywords: Stenotrophomonas maltophilia; acute myeloid leukemia (AML); hematopoietic stem cell transplantation (HSCT); neutropenic enterocolitis (NEC).

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Figures

Figure 1.
Figure 1.
(A) Diffuse intestinal wall thickening was observed on CT. (B-D) Gross pathologic and histologic findings of neutropenic enterocolitis. (B) Erosion, patchy hemorrhaging, and edema were found throughout the lower intestinal tract, particularly in the terminal ileum. (C) low power and (D) highest power: Gram-negative bacilli (arrows) infiltrating all layers of the ileum were seen on a histologic examination.
Figure 2.
Figure 2.
Patient’s clinical course. *Methylprednisolone was administered at 1,000 mg/day for 3 days. PSL: prednisolone, mPSL: methylprednisolone, MMF: mycophenolate mofetil, TAC: tacrolimus, BDP: beclomethasone dipropionate, AMPC/CVA: amoxicillin/clavulanate, CZOP: cefozopran, MEPM: meropenem, PIPC/TAZ: piperacillin/tazobactam, CPFX: ciprofloxacin, VCM: vancomycin, TEIC: teicoplanin, MINO: minocycline, ST: trimethoprim-sulfamethoxazole, MEC: mitoxantrone, etoposide, and cytarabine, WBC: white blood cell, CRP: C-reactive protein
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References

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