meropenem and Anemia--Aplastic

Emphysematous gastritis is a life-threatening disease. It is characterized by the presence of gas within the wall of the stomach. The etiology includes firstly infections with gas-forming organisms; other predisposing causes are the ingestion of corrosive substances and alcohol abuse. Diagnosis is based on radiological techniques, mainly computed tomographic scan (CT). The election treatment is antibiotics and surgery. The evolution is generally fatal. We present the first known case reported, which is associated with aplastic anemia with immunosuppressive therapy, its evolution with medical treatment and a literature review.

Topics: Anemia, Aplastic; Antilymphocyte Serum; Cholelithiasis; Cyclosporine; Emphysema; Female; Gastritis; Granulocyte Colony-Stimulating Factor; Humans; Immunosuppressive Agents; Meropenem; Methylprednisolone; Metronidazole; Middle Aged; T-Lymphocytes; Thienamycins; Tomography, X-Ray Computed

Topics: Acute Disease; Amikacin; Anemia, Aplastic; Antilymphocyte Serum; Combined Modality Therapy; Cyclosporine; Drug Therapy, Combination; Escherichia coli Infections; Gastric Mucosa; Gastritis; Granulocyte Colony-Stimulating Factor; Immunosuppressive Agents; Meropenem; Methylprednisolone; Necrosis; Neutropenia; Omeprazole; Parenteral Nutrition, Total; T-Lymphocytes; Thienamycins

A 61-year-old woman with aplastic anemia was admitted to our hospital in October 2009 because of fever and abdominal pain. She had been treated with cyclosporin A without showing any effect. On admission, uterine cancer was diagnosed and the left uterine appendages were swollen. She was treated with cefepime for febrile neutropenia without effect, and left-sided adnexitis was diagnosed. After cefepime was changed to meropenem, marked plasmacytosis was observed in the peripheral blood (23%) and bone marrow (79%) with the appearance of skin eruption. Although the plasma cells were morphologically abnormal, the cytoplasmic immunoglobulin light chain deviation was not detected by flow cytometric analysis, and M protein was not found by serum immunoelectrophoresis. She was diagnosed with reactive plasmacytosis and treated with dexamethasone. The drug eruption and plasmacytosis improved soon after starting the treatment. Although reactive plasmacytosis is observed with a variety of conditions, including infection, neoplasms, autoimmune disorders, and hemolytic anemia, it has not been reported to accompany drug eruption. Reactive plasmacytosis is sometimes not possible to distinguish from plasma cell neoplasms on morphology alone and needs to be diagnosed comprehensively by using flow cytometric analysis and immunohistochemical evaluation.

Topics: Anemia, Aplastic; Cefepime; Cephalosporins; Cyclosporine; Dexamethasone; Diagnosis, Differential; Drug Eruptions; Female; Flow Cytometry; Humans; Meropenem; Middle Aged; Plasma Cells; Thienamycins; Treatment Outcome

Listeria monocytogenes is highly susceptible to meropenem in vitro, but data on the efficacy of meropenem in clinical cases of listeriosis are scarce. Described here is the case of a child with aplastic anemia who acquired nosocomial listeriosis and failed to respond to initial meropenem therapy. Resolution of fever was not noted after 5 days of therapy with meropenem and, more importantly, clinical worsening was observed during this period. The patient began to improve after ampicillin was introduced to the therapeutic regimen. In total, meropenem was administered for 15 days and ampicillin for 10 days.

Topics: Ampicillin; Anemia, Aplastic; Child, Preschool; Cross Infection; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunocompromised Host; Listeria monocytogenes; Listeriosis; Male; Meropenem; Risk Assessment; Severity of Illness Index; Thienamycins; Treatment Failure