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.