Concurrent invasive pulmonary aspergillosis and neutropenic enterocolitis in a patient with acute severe non-malignant neutropenia: a case report

The complication profile of non-malignant neutropenia is generally determined by its short duration, mild severity and preservation of the mucosal barrier. Atypical cases of this pattern may delay diagnosis and appropriate management. We report a rapidly progressive case of severe non-malignant neutropenia and its related complications in a 65-year-old Romanian woman who had essential arterial hypertension grade II, coronary artery disease, non-stenotic carotid atheromatosis, insulin-dependent type II diabetes mellitus, Graves’ disease as chronic conditions and a repeated history of syncope. The most recent syncope resulted in the post-traumatic musculotendinous rupture of the right vastus lateralis, which required surgical intervention. Preliminary assessments carried out in several specialized medical departments ruled out other acute pathologies, the treatment adjustments made prompted the resumption of thiamazole treatment for Graves’ disease; additionally analgesics, anticoagulants and prophylactic antibiotics were administered. In terms of clinical evolution, the rapid worsening of additional digestive and respiratory symptoms prompted reevaluation of the patient, which revealed the severe neutropenia, the onset of invasive pulmonary aspergillosis, neutropenic enterocolitis, bloodstream infection with Acinetobacter baumannii and Klebsiella pneumoniae , and the reactivation of cytomegalovirus infection. The diagnosis and timing of these complications were documented through serial laboratory and imaging assessments. Despite adaptation of the antimicrobial therapy to the neutropenic context and the sensitivity of the pathogens, as well as antifungal and antiviral treatment and intensive supportive care, the patient progressed to septic shock and died 20 days after neutropenia onset. This case highlights the potential for the rapid and severe evolution of neutropenia and its related complications, which may also be nosocomial, through pathological conditions induced by certain chronic diseases. Early recognition, accurate diagnosis, and multidisciplinary approaches can improve patient outcomes.