A case report on the management of sepsis complicated by eroded mixed hemorrhoids following breast cancer chemotherapy

Rationale: Sepsis is a life-threatening complication in breast cancer patients undergoing chemotherapy, particularly when compounded by anorectal conditions. The management of eroded mixed hemorrhoids in the setting of severe chemotherapy-induced neutropenia and septicemia presents a clinical dilemma, as standard surgical interventions carry prohibitive risks. This case report details a successful conservative, multimodal approach to this rare and critical scenario. Patient concerns: A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer developed a high fever (40.1°C) 1 week after her first cycle of neoadjuvant TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) chemotherapy. She presented with severe bone marrow suppression and constipation, which led to the manual reduction of prolapsed hemorrhoids, resulting in an eroded, inflamed perianal mass. Diagnoses: The patient was diagnosed with septicemia (confirmed by Escherichia coli bacteremia), chemotherapy-induced grade IV bone marrow suppression (white blood cell count 0.17 × 10 9 /L, platelet count 6 × 10 9 /L), and mixed hemorrhoids with erosion and secondary perianal infection. Interventions: Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented. This included broad-spectrum systemic antibiotics (meropenem, vancomycin, amikacin, amphotericin B sequentially), aggressive hematologic support (granulocyte colony-stimulating factor, blood transfusions), and meticulous multimodal local wound care. The local regimen comprised saline cleansing, infrared therapy, recombinant human epidermal growth factor gel, zinc oxide ointment, compound borneol ester suppositories, and the topical application of a self-prepared traditional Chinese medicine, “Liuhe Dan.” Outcomes: After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved. The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care. Lessons: This case demonstrates that in severely neutropenic and thrombocytopenic patients, a conservative, integrated approach combining systemic anti-infective therapy with advanced local wound care and traditional Chinese medicine can successfully manage life-threatening sepsis originating from eroded hemorrhoids. It underscores the critical importance of perianal hygiene, prompt management of chemotherapy-induced constipation and bone marrow suppression, and the potential of nonsurgical strategies in high-risk surgical candidates.