Consultant Corner: Abdominal Pain and the Immunocompromised Patient

Immunocompromised patients often lack the classic clinical abdominal pain presentations, making the etiology difficult to ascertain. Knowledge of the patient’s immunocompromised status, whether it is due to chemotherapy, transplantation, HIV, or autoimmune disease, will help clinicians assess the unique complications that arise in each of these patient populations. In patients with an immunocompromised status, localized infections can quickly become systemic, and timing of antibiotic administration is crucial. In addition, toxicity to medications such as chemotherapeutics, steroids, antiretroviral, and immunosuppressive agents can cause numerous gastrointestinal abnormalities. Imaging should be considered when there is a concern for an infectious complication such as abscess or a possible surgical issue such as perforation, small bowel obstruction, or large bowel obstruction. If the CT is negative, a gastroenterology consult may be needed to continue the workup. Whether that workup should be conducted on an inpatient versus outpatient basis depends upon the need for IV pain control, PO tolerance (oral intake), or presence of concerning signs/symptoms such as fever, leukocytosis, or GI bleeding.