Reactions 1680, p42 - 2 Dec 2017 Neutropenia, neutropenic enterocolitis and Gardnerella vaginalis infection: case report A 54-year-old woman developed neutropenia, neutropenic enterocolitis and Gardnerella vaginalis infection during treatment with cyclophosphamide, methotrexate, fluorouracil and paclitaxel [routes and dosages not stated]. The woman was diagnosed with breast cancer in 2014. She received treatment with cyclophosphamide, methotrexate and fluorouracil for five months. The chemotherapy treatment was completed. Later, in April 2016, she was hospitalised with an extensive hepatic metastases. A liver biopsy findings were consistent with breast adenocarcinoma. Stage-II lobular breast carcinoma with liver and bone metastasis was considered. She received treatment with paclitaxel, with last course administered six days before the hospitalisation. She received a treatment with filgrastim for a WBC count of 1.5 × 10 /L; her WBC increased to 5.8 × 10 /L two days later. A day prior to the hospitalisation, she developed fever, rigor and chills requiring medical attention. In the emergency department, her body temperature and HR were found to be 39.2°C and 118 beats/min, respectively. She also developed dry cough and nausea. Laboratory investigations were consistent with profound neutropenia. Her WBC count was 0.6 × 10 /L. The woman started receiving treatment with filgrastim and cefepime. At second day, she was afebrile. Her WBC count increased to 1.2 × 10 /L. On day 3, the blood cultures were positive for pinpoint gram-negative rods on chocolate agar. A CT scan findings were consistent with neutropenic enterocolitis, and extensive abdominal and pelvic ascites. She started receiving treatment with metronidazole. By day 5, her WBC count rose to 47.7 × 10 /L and later, began to decrease. On day 6, blood culture was positive for G. vaginalis. On day 7, a central catheter line was inserted. On day 8, a speculum examination demonstrated a physiologic discharge and an atrophic vaginal mucosa. She continued to remain afebrile with a WBC count of 15 × 10 /L. On day 9, she was discharged on various treatment medications [not all outcomes stated]. Author comment: "This case documents the first case of G. vaginalis bacteremia in a female immunocompromised patient, with only a distant gynecologic history." Saikali P, et al. An Unusual Case of Gardnerella vaginalis: Bacteremia in an Immunocompromised Female Host. Infectious Diseases in Clinical Practice 25: 282-283, No. 5, Sep 2017. Available from: URL: http://doi.org/10.1097/ IPC.0000000000000516 - USA 803284236 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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