Unique case of non-neutropaenic typhlitis in an immunosuppressed liver transplant patient

Description 

Typhlitis (also known as typhlenteritis or neutropaenic enterocolitis) is a recognised complication of immunosuppression following solid organ transplantation with tacrolimus increasingly thought to be a significant risk factor.1 It is characterised by transmural inflammation of the caecum and terminal ileum and is classically described as a triad of abdominal pain, fever and neutropaenia.2 The causative organism is often a Gram-positive enterococcus3 and typically affects immunosuppressed patients such as those undergoing neoplastic chemotherapy for haematological malignancies, postorgan transplantation or in patients with acute leukaemia or AIDS.

We describe the case of a 63-year-old woman presenting to the emergency department following two episodes of collapse, peritonitis, septic shock with acute renal failure and an elevated lactate of 10. Examination revealed generalised abdominal tenderness with peritonism. Her complete blood count was as follows: White blood count (WBC) 27.1, Red cell count 3.79, Haemoglobin 113, Haematocrit 0.345,...

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