Hanekom WA, Heald LM, Yogev R, Chadwick EG; International Conference on AIDS.
Int Conf AIDS. 1996 Jul 7-12; 11: 113 (abstract no. We.B.3325).
Children's Memorial Hospital, Division of Infectious Diseases, Chicago, IL, USA. Fax: (312) 880-8226. E-mail: whanekom@nwu.edu.
Objective: Description of experience with typhlitis in pediatric HIV infection. Methods: Retrospective review of typhlitis at our HIV clinic (of 120 regular patients) between 1992 and 1995. Typhlitis was defined as a clinical syndrome of fever, abdominal (abd.) pain and tenderness with roentgenographic evidence of right sided colonic inflammation. Results: Five cases of typhlitis occurred, 2 in patients (pts) with perinatally acquired HIV infection, 3 in hemophiliacs. Four pts were CDC stage C3, 1 pt was stage B3. Median CD4+ T cell count was 11/mm3 (range 3-12). Median age was 152 mo. (55-206). All received antiretroviral therapy. Presentation: fever (5 pts), severe abd. pain (5), acute exacerbation of chronic (greater than 1mo.) abd. pain (3), hematochezia (4; 3 were hemophiliacs), severe abd. distension (2). Median neutrophil count was 741/mm3 (less than 500 in 2 pts). Hemoglobin was less than 10 g/dl in 3 pts. Abd. computed tomography (CT) was diagnostic in all pts; ultrasound suggested the diagnosis in 3 pts. Imaging findings: cecal (with/without surrounding bowel) involvement (5 pts), diffuse colonic involvement (1), bowel wall thickening (5), perivisceral inflammatory changes (3), pneumatosis coli (2 pts; both were on treatment for Mycobacterium avium-intracellulare (MAI) infection; 1 had histologic evidence of MAI disease in the bowel wall on autopsy). Other blood and stool cultures were negative. Management included broad spectrum intravenous antimicrobials (duration 5-8 wks), bowel rest and intravenous nutrition. None required surgical management. Abd. symptoms relapsed in 3 pts resulting in readmission; all responded to prolonged bowel rest. Follow-up: complete radiologic resolution within 1 mo. in 3 pts (pneumatosis coli resolved within 5 days); residual abnormal CT findings at 1 mo. in 2 pts although clinically improved. Neutropenia, when present, resolved with G-CSF therapy. Four pts died after a median period of 5.5 mo. after presentation of causes unrelated to typhlitis. Conclusions: 1. Typhlitis in the setting of HIV infection is associated with severe immunodeficiency and occurs at the terminal stages of the disease. 2. Typical presenting symptoms include fever, acute abd. pain and hematochezia. 3. CT is most valuable for abd. imaging. 4. Pneumotosis coli may be present and resolves rapidly with therapy. 5. Aggressive antimicrobial therapy (and adequate bowel rest) is necessary to prevent symptomatic relapse. 6. In contrast to experience with typhlitis in oncology pts, neutropenia was not invariably present, surgical therapy was not required, and no deaths were attributed to typhlitis.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Appendix
- CD4 Lymphocyte Count
- Child
- Enterocolitis, Necrotizing
- Fever
- HIV Infections
- Humans
- Inflammation
- Intestines
- Mycobacterium avium-intracellulare Infection
- Neutropenia
- Tomography, X-Ray Computed
- radiography
Other ID:
UI: 102219573
From Meeting Abstracts