35 - Neutropenic Fever Case Study Flashcards
What is a neutropenic fever?
Diagnosis requires two things
Fever (temp > 38.3 or recurrent temp > 38)
Neutropenia (polys + bands
How serious is neutropenic fever?
Fever in a neutropenic patient should be considered a medical emergency
How severe will the signs of inflammation be in neutropenic fever?
In the absence of neutrophils, signs of inflammation can be extremely subtle **
You will NEED to have a high level of suspicion
What is relatively contraindicated in the case of neutropenic fever?
Rectal exam ***
What is important to recognize about neutropenic patients?
Recognize that physical signs in neutropenic patients may be subtle as patients are unable to generate a significant inflammatory response
What is the definition of neutropenia?
Poly + Bans is less than 500*****
Here is a case study…
A 72 y/o diabetic with diabetic neuropathy that you have been following in your clinic for charcot foot arthropathy unfortunately develops a recurrence of lung cancer. He is not a surgical candidate and is started on chemotherapy. Five days after his last chemotherapy session, he is admitted to the oncology floor with fevers. His ANC on admission was 1000/ul, but now 2 days later has decreased to 100/ul. He remains febrile. He was started on appropriate antibiotic therapy by the admitting oncologist. The oncologist has not found any signs of infection on his physical exam. No cultures have grown any pathogens. You have been consulted to help with management of his toe nails. You examine his foot and note a very small (1cm in diameter), unimpressive, slightly fluctuant, non-painful, only slightly erythematous, and not warm to touch area on the plantar aspect of his right great toe.
What is the appropriate action?
- Do not cut his toe nails
- Recognize that although this is subtle, it is concerning
- Know that the infection will not present with a lot of inflammation
- Consult the attending
