Improvement of pneumatosis cystoides intestinalis after steroid tapering in a patient with bronchial asthma: a case report

Abstract

IntroductionWe report the case of a patient who was diagnosed as having pneumatosis cystoides intestinalis while being treated with prednisolone for bronchial asthma. Even before we had experienced a case of this, the relationship between pneumatosis cystoides intestinalis and prednisolone was unclear. In this case, pneumatosis cystoides intestinalis was improved with the reduction of prednisolone, and therefore we thought a direct relationship between pneumatosis cystoides intestinalis and prednisolone might become clear, such as whether it is dose dependent.Case presentationA 62-year-old Japanese woman had been treated for bronchial asthma for approximately 40 years. She presented with abdominal distension, and a radiographic examination showed intraperitoneal free gas and intramural gas, suggestive of pneumatosis cystoides intestinalis. However, when her prednisolone dose was decreased from 30mg to 0mg for approximately a year because of improvement in her asthma symptoms, her abdominal symptom resolved, and the frequency of her bowel movements returned to normal.ConclusionAmelioration of pneumatosis cystoides intestinalis was observed with tapering of the prednisolone, suggesting that prednisolone may have been involved in the pathogenesis of pneumatosis cystoides intestinalis in this patient.

Pneumatosis Intestinalis Complicated by Pneumoperitoneum in a Patient with Asthma

“…Bowel infarction was shown by abdominal X-ray, and the patient underwent exploration and a double ileostomy. In the third case, a 25-year-old woman with asthma developed PI after high-dose prednisolone 6 . She reported chronic abdominal pain, but her symptom resolved after tapering of the prednisolone.…”

“…The primary type, which is not associated with other diseases, accounts for about 15% of the cases, and the secondary type accounts for the remaining 85% of the cases 2 . More than 58 diseases are associated with the secondary type including gastrointestinal, pulmonary, connective tissue, and hematological diseases 1 , 6 . The clinical manifestations and prognosis of PI are diverse and reflect those of the associated disease 3 .…”

“…PI associated with asthma is extremely rare and, to our knowledge, only three cases have been reported worldwide 4 , 5 , 6 . We present a case of a patient who was diagnosed with asthma and later developed PI, which was detected incidentally by follow-up X-ray.…”

Pneumatosis intestinalis in oncologic patients: when should the radiologist not be afraid?

“…Patients with cancer usually receive immunosuppressive or steroid therapies that may induce lymphoid depletion in Peyer’s patches, which impairs the gastrointestinal defence mechanism, reduces peristalsis and compromises the intestinal wall integrity. 7 , 8 Some authors have observed an association between steroids and PI, 7 , 13 with an improvement of PI after tapering steroids, 7 but there is no statistical association between PI and the amount of steroids or chemotherapeutic agents (cisplatin, fluorouracil, gemcitabine, bevacizumab). 13 Some authors have suggested that PI can be considered benign when confined to the colon and in the absence of “worrisome” CT scan findings such as bowel dilatation, bowel wall thickening, mesenteric stranding, ascites and portomesenteric venous gas.…”

Pneumatosis intestinalis in an adult patient with antral stenosis and midgut malrotation

“…Almost 15% of PI cases are primary or idiopathic and 85% are secondary which can be resulted from a wide spectrum of GI or systemic diseases, although primary PI is benign and asymptomatic, but abdominal pain is the most frequent symptom of secondary PI6 and some of the secondary PI causes are life threatening 1–3 5–8…”