Bacillus cereus Typhlitis in a Patient with Acute Myelogenous Leukemia: A Case Report and Review of the Literature

Table 1

Summary of literature review findings.

Reference Number	Author	Summary
[5]	Uchino et al.	This article reports 13 cases of septicemia caused by B. cereus. Uchino et al. report a case fatality rate of 25% and found that the presence of liver and CNS involvement portended a poorer prognosis. Clindamycin resistance was found to be high in this series (76.9%), and Uchino et al. recommend against using clindamycin and carbapenems in the empiric treatment of B. cereus infections.
[6]	Frankard et al.	This article reports a case of pneumonia caused by B. cereus in the context of a neutropenic patient with ALL. This patient was treated with VCN and demonstrated clinical improvement. She was readmitted 3 weeks later with a recurrent pneumonia due to Streptococcus spp., and she expired due to this later infection.
[7]	Marley et al.	Marley et al. report a case of meningoencephalitis occurring in a patient undergoing induction chemotherapy for AML. The patient became febrile with an ANC of 20/mm^3. Over several hours, the patient experienced a rapid deterioration of mentation, and a CT scan revealed multiple enhancing lesions in the brain. The patient died 12 hours following the onset of neurological symptoms. Autopsy additionally found multiple liver abscesses.
[8]	Le Scanff et al.	Le Scanff et al. report a case of necrotizing gastritis in a female patient with AML 63 days following induction chemotherapy initiation. The patient developed severe epigastric pain and massive hematemesis leading to hemodynamic instability; blood and gastric mucosal cultures revealed B. cereus. This patient was successfully treated with combination of VCN and imipenem.
[9]	Inoue et al.	This substantial article reports 23 cases of B. cereus bacteremia in HM patients, with 12 of these patients developing a frank sepsis. Inoue reports a case fatality rate of 25% for B. cereus sepsis. Further, independent risk-factor analysis concluded that a low ANC, CV catheterization, and CNS symptoms were all significantly associated with a poorer prognosis.
[10]	Ginsburg et al.	Ginsburg et al. report a fatal case of B. cereus sepsis that arose in a 22-year-old male following induction chemotherapy for AML. On hospital day 5, the patient became febrile and neutropenic and a CT scan revealed findings consistent with colitis, but stool C. difficile testing remained negative. His symptoms resolved by hospital day 14 with metronidazole and imipenem. However, 6 days later, he developed diffuse abdominal pain and blood cultures revealed B. cereus. VCN and ampicillin were added, but a new CT revealed pancolitis and multiple hypodense lesions in the liver. The patient expired on the thirty-fourth hospital day. Autopsy confirmed the presence of B. cereus in the liver microabscesses.
[11]	Musa et al.	This case series describes 3 patients, 2 with AML and 1 with ALL, who develop septicemia due to B. cereus. All 3 patients died despite treatment with amikacin. Additionally, all 3 patients developed a similar syndrome of abnormal posturing and clinical signs of brain stem death. 1 patient in this case series was found to have elevated liver enzymes and serum bilirubin perimortem.
[12]	Akiyama et al.	Akiyama et al. report a case of fatal B. cereus septicemia in a 64-year-old patient with AML undergoing induction chemotherapy. Autopsy revealed a necrotizing infection in the leptomeninges of the brain and spinal cord and numerous microabscesses of the liver. B. cereus was present within these lesions.

CNS = central nervous system; ALL = acute lymphoblastic leukemia; VCN = vancomycin; AML = acute myelogenous leukemia. ANC = absolute neutrophil count. CT = computed tomography. HM = hematologic malignancy. CV = central venous. C. difficile = Clostridium difficile.