Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease
characterized by the presence of gas in the intestinal wall. Aim: We
report two rare cases of PCI that are complicated during the chemotherapy for
pulmonary nontuberculous mycobacterial (NTM) disease. CasePresentation:
In this report, we described two cases (a 72-year-old woman and a60-year-old woman) of PCI that
appeared during the combined chemotherapy consisting of rifampicin, ethambutol
and clarithromycin. Because there were few clinical symptoms and increased
inflammatory responses, the diagnosis of PCI was delayed. However, there were
fortunately no severe complications in both cases. Conclusion:
Respiratory physicians should be aware of the potential development of PCI in patients during the chemotherapy for pulmonary NTM disease. It is important to detect PCI in the early stage through
radiological examinations to avoid severe complications.
References
[1]
Du Vernoy, J.G. (1730) Aer intestinorum tam sub extima quam intima tunica inclusus: Observationes anatomicae: Comment. Acacemiae Scientiarum Imperials Petropolitanae, 5, 213-225.
[2]
Uryu, K., Umakoshi, T., Hyakutake, T., Hasegawa, Y., Asano, K. and Harada, H. (2010) Pneumatosis Cystoides Intestinalis in a Patient with Lung Cancer. Nippon Kokyuuki Gakkai Zasshi, 48, 972-975. (In Japanese)
[3]
Iida, A., Naito, H., Tsukahara, K., Yumoto, T., Nosaka, N., Kawana, S., et al. (2017) Pneumatosis Cystoides Intestinalis Presenting as Pneumoperitoneum in a Patient with Chronic Obstructive Pulmonary Disease: A Case Report. Journal of Medical Case Reports, 11, Article No. 55. https://doi.org/10.1186/s13256-017-1198-2
[4]
Sacks, C.A. (2019) Pneumatosis Cystoides Intestinalis with Pneumoperitoneum. The New England Journal of Medicine, 380, e17. https://doi.org/10.1056/NEJMicm1808960
[5]
Maeda, A., Nakata, M., Shimizu, K., Yukawa, T., Saisho, S. and Okita, R. (2016) Pneumatosis Intestinalis after Gefitinib Therapy for Pulmonary Adenocarcinoma: A Case Report. World Journal of Surgical Oncology, 14, Article No. 175. https://doi.org/10.1186/s12957-016-0926-1
[6]
Iwasaku, M., Yoshioka, H., Korogi, Y., Kunimasa, K., Nishiyama, A., Nagai, H., et al. (2012) Pneumatosis Cystoides Intestinalis after Gefitinib Therapy for Pulmonary Adenocarcinoma. Journal of Thoracic Oncology, 7, 257. https://doi.org/10.1097/JTO.0b013e3182381564
[7]
Syed, M.P., Thapa, S., Kate, Y., Subedi, P. and Chemmanur, A. (2021) Pneumatosis Cystoides Intestinalis in the Setting of Clindamycin Use: An Association or a Coincidence? Balkan Medical Journal, 38, 53-54. https://doi.org/10.4274/balkanmedj.galenos.2020.2020.3.69
[8]
Yamasaki, M., Teshima, H., Okanobum, H. and Hattori, N. (2019) Pneumatosis Cystoides Intestinalis in Pulmonary Mycobacterial Disease. British Journal of Hospital Medicine, 80, Article ID: 12968. https://doi.org/10.12968/hmed.2019.80.6.iii
[9]
Wu, L.L., Yang, Y.S., Dou, Y. and Liu, Q.S. (2013) A Systemic Analysis of Pneumatosis Cystoides Intestinalis. World Journal of Gastroenterology, 19, 4973-4978. https://doi.org/10.3748/wjg.v19.i30.4973
[10]
Greenstein, A.J., Nguyen, S.Q., Berlin, A., Corona, J., Lee, J., Wong, E., et al. (2007) Pneumatosis Intestinalis in Adults: Managements, Surgical Indivations, and Risk Factors for Mortality. Journal of Gastrointestinal Surgery, 11, 1268-1274. https://doi.org/10.1007/s11605-007-0241-9
[11]
Khall, P.N., Huber-Wagner, S., Ladurner, R., Kleepies, A., Siebeck, M., Mutschler, W., et al. (2009) Natural History, Clinical Pattern, and Surgical Consideration of Pneumatosis Intestinalis. European Journal of Medical Research, 14, Article No. 231. https://doi.org/10.1186/2047-783X-14-6-231
[12]
Keyting, W.S., McCarver, R.R., Kovarik, J.L. and Daywitt, A.L. (1961) Pneumatosis Intestinalis: A New Concept. Radiology, 76, 733-741. https://doi.org/10.1148/76.5.733
[13]
Gillon, T., Tadesse, K., Logan, R.F., Holt, S. and Sircus, W. (1979) Breath Hydrogen in Pneumatosis Cystoides Intestinalis. Gut, 20, 1008-1011. https://doi.org/10.1136/gut.20.11.1008
[14]
Sugihara, Y. and Okada, H. (2017) Pneumatosis Cystoides Intestinalis. The New England Journal of Medicine, 377, 2266. https://doi.org/10.1056/NEJMicm1701357
[15]
Suzuki, E., Kanno, T., Hazama, M., Kobayashi, H., Watanabe, H. and Ohira, H. (2017) Four Cases of Pneumatosis Cystoides Intestinalis Complicated by Connective Tissue Diseases. Internal Medicine, 56, 1011-1016. https://doi.org/10.2169/internalmedicine.56.7877
[16]
Ammons, M.A., Bauling, P.C. and Weil III, R. (1986) Pneumatosis Cystoides Intestinalis with Pneumoperitoneum in Renal Transplant Patients on Cyclosporine and Prednisolone. Transplantation Proceedings, 18, 1868-1870.
[17]
Thornton, E., Howard, S.A., Jagannathan, J., Krajewski, K.M., Shinagare, A.B., O’Regan, K., et al. (2012) Imaging Features of Bowel Toxicities in the Setting of Molecular Targeted Therapies in Cancer Patients. The British Journal of Radiology, 85, 1420-1426. https://doi.org/10.1259/bjr/19815818
[18]
Coriat, R., Ropert, R., Mir, O., Billemont, B., Chaussade, S., Massault, P.P., et al. (2011) Pneumatosis Intestinalis Associated with Treatment of Cancer Patients with the Vascular Growth Factor Receptor Tyrosine Kinase Inhibitors Sorafenib and Sunitinib. Investigational New Drugs, 29, 1090-1093. https://doi.org/10.1007/s10637-010-9458-7
[19]
Morris, M.A., Gee, A.C., Cho, S.D., Limbaugh, K., Underwood, S., Ham, B., et al. (2008) Management and Outcome of Pneumatosis Intestinalis. The American Journal of Surgery, 195, 679-682. https://doi.org/10.1016/j.amjsurg.2008.01.011
[20]
Zhang, H., Jun, S.L. and Brennan, T.V. (2012) Pneumatosis Intestinalis: Not Always a Surgical Indication. Case Reports in Surgery, 2012, Article ID: 719713. https://doi.org/10.1155/2012/719713
[21]
Ogul, H., Pirimogglu, B., Kisaoglu, A., Karaca, L., Havan, N., Ozoglu, B., et al. (2015) Pneumatosis Cystoides Intestinalis: An Unusual Cause of Intestinal Ischemia and Pneumoperitoneum. International Surgery, 100, 221-224. https://doi.org/10.9738/INTSURG-D-13-00238.1
