Unexpected diagnosis of appendicitis in a paediatric patient with febrile neutropaenia and acute myeloid leukaemia

Abstract

Due to the persistent fevers, a CT scan of the chest, abdomen and pelvis was ordered which showed an acute appendicitis with abscess formation (figure 1). Appendectomy demonstrated acute necrotising appendicitis on pathological review without evidence of leukaemic involvement. He recovered well and became afebrile. Eight days later, fevers without abdominal symptoms recurred. Repeat CT scanning showed a large abscess in the right lower quadrant (figure 2). This was subsequently drained and cultures grew Pseudomonas. He received cefepime, metronidazole, tobramycin and filgrastim and subsequently recovered. He was discharged home when his neutrophil counts recovered 11 days later.