PERIANAL INFECTIONS IN PATIENTS WITH LEUKEMIA - IMPORTANCE OF THE COURSE OF NEUTROPHIL COUNT

PURPOSE: This study was performed to evaluate relations among neutroph il count (including its course), type of lesion, treatment, and progno sis in patients with leukemia and perianal infection. METHODS: Medical records of patients with acute and chronic leukemia who were followed during the last five years were reviewed retrospectively. RESULTS: Th e incidence of perianal infections was found to be 7.3 percent in 259 patients with acute leukemia. Only 1 of 108 patients with chronic leuk emia suffered from this problem. Twenty percent of all patients with t his complication died as a result of sepsis. Perianal abscess was the sole and obligatory indication for surgical treatment in our patients. There were ten patients in each treatment group. The operative group had better results (9 cures, 1 complication vs. 3 cures, 7 complicatio ns). However, median neutrophil count at diagnosis was notably higher in the operative group 1,280/mm(3) vs. 96/mm(3); P = 0.075). Also, sig nificantly more frequent abscess formations and, consequently, operati ve treatments were performed in patients with a period of normal neutr ophil counts during the infection compared with continuously neutropen ic patients (9 operative, 4 nonoperative vs. 1 operative, 6 nonoperati ve; P = 0.057). Ten cures, three complications vs. two cures, five com plications (3 mortalities) were present in patients with and without n ormal neutrophil counts, respectively (P = 0.062). When only severely neutropenic patients were considered, four patients in the surgery gro up had normal neutrophil counts before or shortly after surgery. Howev er, only two of eight patients with perianal cellulitis had normal cou nts during full-course infection (P = 0.06). CONCLUSIONS: The course o f the neutrophil count during infection was an important factor affect ing the perianal lesion, and indirectly, choice of treatment and progn osis. A period of normal counts during infection usually led to well b ordered and fluctuant lesions, and the prognosis was acceptable with o perative treatment. However, continuously neutropenic patients develop ed nonfluctuating indurations. We found disappointing results with non operative treatment of such patients. In all studies, regarding treatm ent of perianal infections in neutropenic patients, the course of the neutrophil count and indications for surgery should be clarified to ge t reliable results.