Booklet for Hemato-Oncologists
Case 5 (A, B) - Abdominal pain with distension and stomatitis, no fever at the end of intensive treatment for HR-ALL
Child, 7 years old, female, affected by HR-ALL, treated according to ALL-BFM protocol. At the end of intensive treatment (HR1, HR2, HR3 blocks) she complained severe abdominal pain with distension and stomatitis without fever.
A - What would you do when abdominal pain occurs in a granulocytic patient (ANC < 1,000/µl)?
1. Consultation with surgeon
2. Give anti-pain medications
3. Start antibiotic therapy in any case independently from cultures
4. Perform immediately abdomen X-ray or ultrasonography
5. Look for persistence of peristalsis, presence of diarrhea and/ or test infections agents in the same time, because Gram negative infection and Clostridium Difficile also can cause abdominal pain.
B - What are your first choices of diagnosis?
1. Fungal infection
2. Viral infection
3. Clostridium difficile infection
4. Gram-negative infection
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