CASE 5
Patient 5 was a 58 year old male with history of myeloma/plasma cell
leukemia who obtained a partial response (PR) after 4 cycles of
cyclophosphamide, bortezomib, dexamethasone (CyBorD) and later
bortezomib, thalidomide, dexamethasone, cisplatin, doxorubicin,
cyclophosphamide and etoposide (VTD-PACE). He received a conditioning
regimen of standard high dose melphalan with autologous peripheral blood
stem cell transplant. He developed mucositis by day + 3 which peaked at
grade 3 toxicity. He developed neutropenic fever on day + 8 and
complained of abdominal pain. A full fever workup was obtained and
patient was started on piperacillin-tazobactam. A subsequent CT scan
showed colonic mucosal hyperenhancement and wall thickening to include a
dilated fluid-filled appendix consistent with diffuse mucosal
inflammation and possible appendicitis (figure 5). Empiric antibiotic
with Piperacillin/Tazobactam was continued for one week and discontinued
after neutrophil engraftment. The patient recovered without
complication.