Febrile neutropenia

Case history

A 57-year-old woman with a history of stage I breast cancer status post-lumpectomy is being treated with doxorubicin and cyclophosphamide every 3 weeks. She had her first treatment 8 days ago and now presents with a temperature of 38.3°C (100.9°F). Vital signs are stable and she has no localising signs or symptoms of infection other than mouth sores. White blood cell count is 550/microlitre with an absolute neutrophil count of 200 cells/microlitre.

Other presentations

Patients with febrile neutropenia related to a deep-seated focus of infection often present without localising signs or symptoms owing to a diminished ability to mount an inflammatory response. Careful attention should be paid to the sinuses and lungs, and to all skin surfaces (including skin folds, bodily orifices, prior surgical or biopsy sites, and intravenous catheter sites) as possible sources of infection.

Patients may occasionally present without fever (particularly if they are receiving corticosteroids) but have other signs and symptoms suggestive of infection (e.g., hypotension, tachycardia).