Febrile neutropenia in a HIV positive individual post-chemotherapy.

摘要

A HIV positive 50-year-old male presented to hospital with a fever of 39(deg)C 8 days after commencing his sixth cycle of CHOP chemotherapy for stage IV B plasmablastic lymphoma. The lymphoma was diagnosed 4 months earlier when he presented with anaemia, weight loss and a peri-anal mass. A HIV test was positive, CD4 count was 18 x 10~ 6cells/L and HIV RNA 500,000 copies/mL Antiretrovirals (tenofovir, emtricitabine, darunavir and ritonavir) and antimicrobial prophylaxis (acyclovir 400 mg BD, fluconazole 50 mg OD, azithromycin 1250 mg weekly and co-trimoxazole 960 mg OD) were initiated prior to commencing cytotoxic chemotherapy. During the first five cycles he had several episodes of neutropenic sepsis, without microbiological diagnosis, treated empirically as per local guidelines.