Differential Diagnosis for Fever and Swollen Colon in a Patient with History of Testicular Cancer Treated with Chemotherapy

• Single Most Likely Diagnosis

  • Neutropenic colitis (typhlitis): This condition is a common complication in patients undergoing chemotherapy, especially those with neutropenia. The symptoms of fever and swollen colon, in the context of recent chemotherapy, make this diagnosis highly plausible due to the patient's compromised immune system and potential for bacterial translocation.

• Other Likely Diagnoses

  • Chemotherapy-induced colitis: Chemotherapy can cause direct injury to the colon mucosa, leading to inflammation and symptoms similar to those presented.
  • Infection (e.g., Clostridioides difficile): Patients on chemotherapy are at increased risk for infections due to their immunocompromised state. C. difficile infection is a common cause of diarrhea and colitis in this population.
  • Graft-versus-host disease (if the patient received a transplant as part of their treatment): Although less common, if the patient underwent a bone marrow or stem cell transplant as part of their cancer treatment, graft-versus-host disease could be a consideration, especially if the symptoms are part of a broader systemic reaction.

• Do Not Miss Diagnoses

  • Bowel obstruction or perforation: These are surgical emergencies that could present with abdominal pain and fever. A swollen colon could be indicative of an obstructive process or impending perforation, both of which require immediate intervention.
  • Septicemia: The combination of fever and a potential source of infection (such as a swollen colon) in an immunocompromised patient raises the concern for septicemia, a life-threatening condition that requires prompt recognition and treatment.

• Rare Diagnoses

  • Metastatic disease to the colon: Although rare, it's conceivable that the patient's testicular cancer could metastasize to the colon, presenting with symptoms of colonic obstruction or inflammation.
  • Radiation colitis (if the patient received radiation therapy): If the patient's treatment included radiation to the abdominal area, radiation colitis could be a consideration, although this would typically present later in the course of treatment or after its completion.