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.