Pneumatosis intestinalis and portal venous gas secondary to Gefitinib therapy for lung adenocarcinoma

The present report describes a case of PI and PVG secondary to treatment with an EGFR tyrosine kinase inhibitor. A 66-year-old woman who had been diagnosed with metastatic lung adenocarcinoma presented with nausea, vomiting and abdominal distension after commencing gefitinib. A computed tomography (CT) scan of the abdomen revealed PI extending from the ascending colon to the rectum, hepatic PVG, and infarction of the liver. Gefitinib therapy was discontinued immediately and the patient was managed conservatively. A follow-up CT scan 2 weeks later revealed that the PI and hepatic PVG had completely resolved.This is the first report of PI and PVG caused by EGFR tyrosine kinase inhibitor. Although these complications are extremely rare, clinicians should be aware of the risk of PI and PVG in patients undergoing targeted molecular therapy.Recent advances in our understanding of the biology and molecular mechanisms of cancer have led to the introduction of molecular-targeted agents for the treatment of non-small cell lung cancer (NSCLC). Gefitinib is an orally active selective inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase, an enzyme that regulates the intracellular signaling pathways implicated in the proliferation and survival of cancer cells [1]. Somatic mutations in the region of EGFR that encodes the tyrosine kinase domain of the receptor have been identified in patients with NSCLC and many studies report that NSCLC patients who carry these mutations are highly responsive to gefitinib [2,3].In general, targeted molecular therapies such as gefitinib have good toxicity profiles. However, some patients develop specific and severe toxicities, since these molecular targets are also expressed in normal cells. Although gefitinib is generally well tolerated, its most commonly reported side effects are of the gastrointestinal tract (diarrhea, nausea and vomiting) and skin (rash, acne, dry skin and pruritus). Severe gastrointestinal toxicity secondar