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Pruritus, sepsis and bowel obstruction: 2 case reports In a case series, a 26-year-old woman was described, who developed pruritus following treatment with filgrastim as recombinant growth factor, and a 86-year-old woman developed sepsis and bowel obstruction during treatment with azacitidine [routes and dosages not stated] for myelodysplastic syndromes (MDS). Case 3: The 26-year-old woman was diagnosed with MDS with deletion of long arm of chromosome 7 and multilineage dysplasia. She was referred for the further management. Due to recurrent infections, she received one dose of filgrastim [Neupogen]. Subsequently, she developed severe itching, which continued for >18 months despite no further treatment with filgrastim. Further, her pruritus became debilitating, intractable and led to long absences at work. She had a history of acid reflux, for which she took ranitidine. Clinical examination of the pruritus showed mild dermatographism, which subsequently became more marked. Excoriations was also observed as her pruritus became more intense. A complete pruritus investigation panel was unremarkable. Bone marrow examination showed no excess mast cells, and positron emission tomography (PET)/CT scan showed no evidence of lymphadenopathy. Her pruritis was thought to be related to filgrastim therapy. She was treated with cetirizine and fexofenadine followed by addition of sodium cromoglicate and montelukast with unspecified emollients and unspecified corticosteroid to her therapy. But no resolution was observed. Thereafter, she received oral prednisolone, followed by trial of amitriptyline and gabapentin, but no relief was observed. She started receiving ciclosporin, following which relief was observed. She remained on ranitidine, fexofenadine and hydroxyzine along with intermittent phototherapy. Case 4: The 86-year-old woman presented with 3 years history of intractable generalised itch. Treatment with various unspecified antihistamines and unspecified corticosteroids did not help her. Doxepin also did not help her to sleep through her symptoms. She received treatment with hydroxyzine, mometasone [mometasone furoate] and unspecified emollients. She also received pregabalin, rivaroxaban, omeprazole and zopiclone. She had a history of high-grade non-Hodgkin’s high-grade lymphoma (diagnosed 33 years prior). The pruritis was thought to be the relapse of her lymphoma. But the PET/CT scan showed no evidence of lymphoma. Due to her severe symptoms, she received trial of prednisolone and rituximab for possible low-grade lymphoma, but no impact on pruritus was observed. After one cycle, she denied further therapy. A few months after the presentation, she developed anaemia, which required transfusion. Bone marrow examination demonstrated MDS with deletion of long arm of chromosome 5 and multilineage dysplasia. She received one cycle of azacitidine [5-azacitidine], which was complicated by bowel obstruction and sepsis. Considering her comorbidities and poor performance status, chemotherapy was stopped. Subsequently, she died,