Snapshot A 68-year-old female on outpatient chemotherapy for non-Hodgkin's lymphoma presents to the Emergency Room with a temperature of 38.4 degrees Celsius. Laboratory tests reveal an absolute neutrophil count of 372/mm^3 Introduction Fever in neutropenic patient > 38.3 degrees Celsius on single oral temp or temp > 38.0 degrees Celsius > 1 hour neutropenia is an absolute neutrophil count (ANC) <500/mm^3 Causes include bone marrow failure or invasion hypersplenism systemic lupus erythematosus AIDS Risk factors cancer patient on chemotherapy catheters skin breakdown obstruction (biliary, GI, lymphatic, urinary tract) Classification Risk stratification low risk solid tumor treated as outpatient neutropenia <10 days no major comorbidity high risk high-dose chemotherapy hematologic malignancy Presentation Symptoms fever may be only manifestation of infection Evaluation Labs pan cultures CBC metabolic panel Radiographs CXR CT scan if abscess suspected Treatment Broad spectrum antibiotics with antipseudomonal activity PO ciprofloxacin + augmentin indicated in low risk patients Ceftazidime, cefepime, carbapenem indicated as monotherapy aminoglycoside + antipseudomonal beta-lactam indicated as 2 -drug therapy vancomycin indicated for high-risk patients or persistent fever > 3-5 days Antifungals indicated if fever > 3 days Colony stimulating factors routine use not indicated