CASE 3
Patient 3 was a 55 year old male with myelofibrosis who received a
reduced intensity conditioning regimen of busulfan and fludarabine with
matched related donor allogeneic peripheral blood stem cell transplant.
His early post-transplant course was complicated by delayed platelet
recovery and serum sickness from antithymocyte globulin GVHD
prophylaxis. He presented on day + 108 with right lower quadrant
abdominal pain and subsequent CT showed an enlarged appendix with a 7 mm
appendicolith, adjacent to phlegmon/abscess and fat stranding (Figure
3). The patient was determined not to be a surgical candidate due to
thrombocytopenia and ongoing immunosuppression with tacrolimus. He
received a two week course of metronidazole and levofloxacin with plan
to receive elective appendectomy after completion of immunosuppression
or sooner if clinical status worsened. The patient clinically recovered
and repeat imaging on day + 195 revealed resolution of the appendicolith
and inflammatory findings. Appendectomy was not pursued given lack of
symptoms and resolution of radiographic findings.