P2055 - Age Is Just a Number: Acute Typhlitis in an Elderly Female Post Renal Transplant

Kosisochukwu Ezeh, MD¹, William Boateng, MD², Yasir Rajwana, MD^3
1Marshall University, Charleston, WV; ²Jersey City Medical Center, Jersey City, NJ; ³Marshall University Joan C. Edwards School of Medicine, Huntington, WV

Introduction: Typhlitis, also known as neutropenic enterocolitis, involves swelling and inflammation primarily in the cecum, ascending colon, and occasionally the terminal ileum. Its occurrence ranges between 3.5 to 5.3%. Typically, resolution aligns with the restoration of neutrophil counts. In this case, we detail the experience of an immunocompromised person presenting with abdominal pain, ultimately diagnosed with acute typhlitis. Given the limited count of documented adult cases and the evident challenges in accurately diagnosing typhlitis, it suggests a potential lack of awareness among physicians regarding this condition.

Case Description/Methods: 69-year-old female with a history of right renal kidney on immunosuppressant (Tacrolimus, mycophenolate, and prednisone) who presented with a complaint of chronic diarrhea with associated right lower quadrant tenderness, and decreased oral intake. Radiological findings of inflammation of the colon restricted to the cecal region. She had been on repeated courses of antibiotics including ciprofloxacin and metronidazole. Stool studies are unremarkable for Clostridium difficile or other pathogens. There was no bacteremia. Unlike the popular term, neutropenic enterocolitis, this patient presented with neutrophilic predominance leukocytosis. She showed clinical and laboratory Improvement in symptoms following intravenous fluid and piperacillin.

Several treatment modalities have been discussed besides the conservative measures mentioned above such as granulocyte colony-stimulating factor, glutamine, and laparoscopy which is utilized for patients with presenting acute abdomen or equivocal findings where appendicitis cannot be radiographically ruled out.

Discussion: Typhlitis is not merely a pathology for the pediatric population. It should also be considered in any immunocompromised patient presenting with right lower quadrant pain with compatible radiographic findings. It is usually treated conservatively with intravenous fluid and antibiotics, however surgical approach such as laparotomy could be necessary.


Disclosures:


Kosisochukwu Ezeh, MD¹, William Boateng, MD², Yasir Rajwana, MD³. P2055 - Age Is Just a Number: Acute Typhlitis in an Elderly Female Post Renal Transplant, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.