Case 13-2014: A 41-Year-Old Man with Fever and Abdominal Pain after Stem-Cell Transplantation

A 41-year-old man with B-cell acute lymphoblastic leukemia underwent allogeneic peripheral-blood stem-cell transplantation; 12 days later, fever, abdominal pain, and peritoneal signs developed. Imaging showed acute retrocecal appendicitis and inflammation of the cecum. Presentation of Case Dr. Ricardo J. Cigarroa (Medicine): A 41-year-old man with B-cell acute lymphoblastic leukemia (ALL) underwent allogeneic peripheral-blood stem-cell transplantation, and afterward, fever and abdominal pain developed. The patient had been well until approximately 7 months before admission, when low-grade fevers and fatigue occurred; the fevers were associated with an unintentional weight loss of approximately 10 kg. Five months before admission, pain in his right arm and leg developed. Imaging performed at another hospital revealed deep venous thromboses, and analysis of a peripheral-blood smear revealed a white-cell count of 33,000 per cubic millimeter, with 53% blasts. Pathological examination . . .