January 17, 2016

Clinical Vignette 52

A young woman was recently diagnosed with Stage II breast cancer. Post-resection, she was started on adjuvant 3-weekly docetaxol, doxorubicin and cyclophosphamide. Ten days after the second cycle, she developed fever and headache, with temperature of up to 38.5 degrees Celsius. She had nausea, but no vomiting or diarrhoea. There was no contact or other significant history of note, and she has no drug allergies. Clinical examination was unremarkable, with a blood pressure of 104/63 mmHg. Her chest X-ray was normal, but she was neutropenic, with an absolute neutrophil count of 0.13 x 10(9)/L.

Question: If she had presented at the outpatient clinic or emergency department, how should she be managed?

[Updated 4 Feb 2016]

This vignette was answered in a subsequent post on febrile neutropenia. Basically, the patient has low risk febrile neutropenia and can be managed outpatient with oral antibiotics.

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Clinical vignette, Infectious diseases