Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3-5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.
Anti-Bacterial Agents/*administration & dosage ; Antibiotic Prophylaxis/*standards ; Antifungal Agents/*administration & dosage ; Drug Administration Schedule ; Evidence-Based Medicine ; Fever/diagnosis/*drug therapy/etiology ; Humans ; Neutropenia/diagnosis/*drug therapy/etiology ; Republic of Korea ; Time Factors ; Treatment Outcome

Upper airway disease, especially nasal and paranasal sinus involvement, is the most common manifestation of Wegener's granulomatosis. Chronic otitis media and facial palsy are rare but well known presenting features of Wegener's granulomatosis. We report a 40-year-old woman who presented with complaints of ear discharge, deep-seated ear pain and loss of hearing in her right ear. Early diagnosis demands heightened suspicion in a patient with otological symptoms and facial paralysis.
Administration, Oral ; Adult ; Biopsy ; Chronic Disease ; Cyclophosphamide ; therapeutic use ; toxicity ; Diagnosis, Differential ; Drug Therapy, Combination ; Facial Paralysis ; etiology ; pathology ; Fatal Outcome ; Female ; Granulomatosis with Polyangiitis ; diagnosis ; pathology ; Humans ; Immunosuppressive Agents ; therapeutic use ; toxicity ; Nasal Mucosa ; pathology ; Neutropenia ; chemically induced ; Otitis Media with Effusion ; etiology ; pathology ; Plasma Exchange ; Prednisolone ; therapeutic use ; toxicity ; Renal Dialysis