Neutropenic Enterocolitis in Acute Myeloid Leukemia and Morbus Behcet: Pivotal Role of Medical Imaging and Multidisciplinary Management in a Complex Clinical Case

Abstract

Background/aim: Neutropenic enterocolitis (NE), also known as typhlitis, is a life-threatening gastrointestinal complication primarily affecting immunocompromised patients undergoing intensive chemotherapy. Its management becomes particularly challenging when compounded by comorbidities such as Behçet's disease with gastrointestinal involvement.

Case report: We report the case of a 44-year-old male with acute myeloid leukemia (AML) and intestinal Behçet's disease who developed severe NE during induction chemotherapy. Initial conservative management was guided by serial cross-sectional imaging, which revealed progressive bowel wall thickening, pneumatosis intestinalis, and signs of ileus. The clinical course was complicated by septic shock, multiorgan dysfunction, and later, acute gastrointestinal hemorrhage. Active arterial bleeding was identified via computed tomography angiography and successfully treated with interventional radiological coil embolization. Surgical intervention was avoided. Multidisciplinary collaboration, including hematology, radiology, rheumatology, intensive care, and pain management, was essential in navigating this complex clinical scenario.

Conclusion: This case highlights the pivotal role of radiological imaging in diagnosing and monitoring NE and demonstrates the value of interventional radiology as a minimally invasive alternative to surgery. In patients with overlapping autoimmune and oncological pathologies, individualized, multidisciplinary management is crucial for optimizing outcomes.

Keywords: Behcet’s disease; Neutropenic enterocolitis; acute myeloid leukemia; typhlitis.