Neutropenic enterocolitis (NE) is a potentially life-threatening disease that primarily occurs in cancer patients treated with chemotherapy. NE has substantial morbidity and mortality, and its incidence has increased with the widespread use of chemotherapeutic agents such as taxanes, gemcitabine, and leucovorin in patients with lung, breast, gastric, and ovarian cancers. Sometimes NE can be a possible cause of death. Although, conservative approaches are often successful, there are currently no standardized treatment guidelines for NE and it is unclear when such strategies should be implemented. Therefore, we present this report to provide a greater insight into the possible treatment of NE.
We report the case of a 72-year-old woman with endometrial cancer who was undergoing treatment for hypertension, obesity and diabetes mellitus. The patient initially developed paralytic ileus on the 6th postoperative day (POD) after surgery for endometrial serous carcinoma. Complete recovery was achieved after 4 days of fasting and fluid replacement therapy. On the 27th POD, she received the first cycle of combination chemotherapy consisting of paclitaxel and carboplatin. On day 5 of chemotherapy, she developed the systemic inflammatory response syndrome including febrile neutropenia and sepsis. She then developed disseminated intravascular coagulation (DIC) and septic shock. The patient was subsequently moved to the intensive care unit (ICU). Despite initiating the standard treatment for septic shock and DIC, her overall status worsened. It was assumed that gut distention had led to bowel damage, subsequently leading to bacterial translocation. Thus, she developed NE with severe DIC and septic shock. We decided to reduce the intestinal pressure using an ileus tube to suction the additional air and fluid, even though doing so had a risk of worsening her general condition. The inflammatory reaction subsided, and her general condition improved. The patient recovered after 18 days in the ICU and was discharged alive.
Herein, we describe a patient with suspected chemotherapy-associated NE. Our observations suggest that postoperative ileus may be one of the possible causes of NE. Patients who experience postoperative ileus must be carefully monitored while undergoing chemotherapy.

While studies indicate differences in incidence and case fatality risk of COVID-19, few efforts have shed light on regional variations in the intensity of initial community spread. We conducted a nationwide study using county-level data on COVID-19 from Center for Systems Science and Engineering at Johns Hopkins University. We characterized intensity of initial community COVID-19 attack by calculating the incidence and case fatality risk (CFR) for the first 4-week period of COVID-19 spread in each county. We used multivariate multilevel multinomial logistic regression to estimate the association of county-level characteristics with COVID-19 incidence and CFR. Of 3,143 counties, we included 1,052 with at least 100 reported cases on June 1st. Median incidence was 193.4 per 100,000 population (IQR: 94.2-397.5). Median case fatality risk was 3.6% (IQR: 1.4-7.3). Median age, rural population, population density, lower education, uninsured population, obesity, COPD prevalence were positively associated, while population, female sex, races (Asian, white), higher education, excessive drinking were negatively associated with initial COVID-19 incidence. Median age, female sex, Asian race, population density, higher education, excessive drinking, Intensive Care Unit beds, airborne infection isolation rooms were positively associated, while Hispanic ethnicity, lower education, obesity (paradox), uninsured population were negatively associated with initial COVID-19 CFR.