Case No 2

22-aged female patient with Ewing sarcoma of ilium on neoadjuvant chemotherapy, admitted to hospital for fever and abdominal pain

Medical History

Present Illness: Nowadays after 4th cycle of NACHT (neoadjuvant chemotherapy). 4 days before the fever up to 38.5 °C, examined on orthopedic department, blood taken for blood count and basic biochemical tests, that reveal pancytopenia and high CRP, presently she complained pain in right lower abdomen, transported to department of infectious diseases

FHx: Nothing of note
EHx: Denies the contact with infection. She underwent outpatient chemotherapy, antibiotics given as a prophylaxis a month ago
WSHx: Secretary, on sick leave, single
PM/SHx: common child diseases, appendectomy, arthroscopy of right knee 2 years ago, surgery of collateral cruciate ligament, half a year ago noted pain in right costal margin, a quarter of year ago – palpable lump, MRI, PET examinations and biopsy helped to establish diagnosis of Ewing sarcoma, port implantation, therapy with protocol NACHT (EURO-E.W.I.N.G.), doses were reduced because aplastic anemia after 3rd cycle of chemotherapy, clinically good response with reduced tumour mass was noted
Allergies: Pollen, dust, drugs well tolerated
Medications: NACHT - now after 4th cycle
Abuse: Patient does not use tobacco, alcohol, illicit drugs

Physical Examination

Vital Signs (Vitals): T: 38.6 °C; HR: 89; RR: 20; BP: 85/69; satO2 97 % on 2L O2
Height/ Weight: h 163 cm, m 68 kg.
General: Patient lying weakened in bed
Psychiatry: Alert and oriented to person, place, and time
Skin: No rash or lesions. Turgor reduced.
Head: NCAT.
Eyes: PERRL, EOMI. No scleral icterus.
ENT: No nasal d/c. MMM. Oropharynx clear with no lesions/erythema. Tonsils normotrophic. Tongue with geographical coating.
Neck: No masses. No thyromegaly. No bruits.
Lymph Nodes: No cervical, axillar or inguinal LAD.
Chest: Symmetric.
Lungs: Breath sounds are bilaterally alveolar, bibasilar decreased. No wheezing or rhonchi appreciated. Good air movement.
Cardiovascular: Rhythm irregular. Heart sounds without murmur. Pulses 2+ equal on both sides.
Abdomen: slightly over niveau, tympanitic (drum-like) sounds on percussion, soft, slightly tender, distended. No masses. No rebound/guarding. No hepatosplenomegaly. Tapottement negative. Bowel sounds barely audible.
Rectal: Not performed.
Extremities: Capillary refill slower. Venous cannula in right forearm.
Musculo-skeletal: Joints flexible without erythema.
Neurological: Cranial nerves II-XII grossly intact. No decrease in strength. Normal sensation throughout.

Laboratory tests

Hematologic tests:

Biochemical tests:

Microbiological examination:

Imaging and other paraclinical examinations



Topogram   Fig 1 Topogram



Native X-ray of the abdomen   Fig 2 Native X-ray of the abdomen


Abdominal CT scan   Fig 3 Abdominal CT scan


Other Paraclinical and Consultation Examinations

Electrophysiologic examinations:

Endoscopic examinations:

Diagnostic Conclusion

Make a diagnosis yourself.


Select correct antimicrobial drugs.


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