zoster infection can rapidly progress to a life-threatening infection in an immunocompromised patient Typhlitis, also known as neutropenic colitis, is a potentially life-threatening infection that occurs in patients with neutropenia and GI mucosal injury This infection occurs in the watershed regions of the cecum, appendix, and terminal ileum It is much more common in patients with advanced hematologic malignancies but can occur in patients with solid tumors Clostridium difficile colitis is relatively common in oncology patients due to treatment with broad-spectrum antibiotics that eradicates normal bowel flora Clinical Considerations Clinical Recognition In addition to sepsis, bacteremia, and soft tissue infections, the emergency clinician should consider additional infectious complications not commonly encountered in noncancer patients Initial symptoms of typhlitis can mimic appendicitis with periumbilical pain preceding right lower quadrant pain As the infection progresses, abdominal pain can become severe and examination findings include distention and persistent right lower quadrant tenderness C difficile colitis should be considered in patients with abdominal pain and diarrhea with or without abdominal distention Abdominal tenderness is generally minimal except in patients with very severe colitis Perirectal pain may be the presenting symptom of perirectal abscess/cellulitis Complaints of painful vesicular rash should raise concern for varicella infection Clinical Assessment Certain elements of the history can be very helpful Patients, family members, or referring oncologists may know if the patient is already neutropenic Specific questions to elicit any focal pain can direct the physical examination and empiric treatment decisions since this may be the only evidence of a localizing infection The presence of any indwelling devices such as a central line, ventriculoperitoneal shunt, or metal hardware used for bone tumors can also guide the differential diagnosis and/or empiric antibiotic coverage Since antibiotic allergies are common in this population, a thorough allergy history is critical The physical examination of the patient must be detailed and meticulous with careful attention paid to all mucocutaneous surfaces to elicit any focal tenderness, erythema, or edema, which may be slight Sites to examine include any central venous access devices at the skin entrance site, subcutaneous reservoirs, and along the subcutaneous line tract Nail beds on both fingers and toes should be carefully examined, and a thorough external rectal examination performed using