Clinically Suspected Neutropenic Enterocolitis Before Documented Neutropenia in a Patient With Breast Cancer: A Case Report

Neutropenic enterocolitis (NE), or typhlitis, is a potentially life-threatening complication of cytotoxic chemotherapy classically characterized by neutropenia, fever, and abdominal pain.However, these features may not develop simultaneously, creating a diagnostic challenge when gastrointestinal symptoms precede documented neutropenia.A 44-year-old woman with invasive ductal carcinoma of the breast presented five days after her fourth overall cycle of adjuvant chemotherapy, documented as docetaxel treatment, with worsening abdominal pain, vomiting, rigors, and constipation.Initial laboratory testing demonstrated an absolute neutrophil count (ANC) of 2.3 × 10⁹/L and a C-reactive protein (CRP) of 20 mg/L, confirming that she was not neutropenic.An initial abdominal radiograph showed fecal loading, providing a plausible early explanation for her symptoms.Within 24 hours, the patient developed pyrexia and profound neutropenia with an ANC of 0.1 × 10⁹/L and CRP rising to 133 mg/L.Subsequent review of the initial abdominal radiograph identified a featureless descending colon with loss of normal haustral markings, raising concern for colitis.She was managed conservatively with intravenous broad-spectrum antimicrobials, fluid support, filgrastim, cautious bowel management, and multidisciplinary review.She achieved clinical improvement and neutrophil recovery without surgical intervention and was discharged on hospital Day 7.This case suggests that gastrointestinal symptoms concerning for NE may precede documented neutropenia.A normal initial neutrophil count should therefore not provide false reassurance when gastrointestinal symptoms develop following chemotherapy and subsequently persist or progress.Serial clinical assessment, repeat hematological testing, appropriate imaging, radiological reassessment, and multidisciplinary review are important when the clinical course evolves.