National Defense Medical Center, Taipei, Taiwan.
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Int J Colorectal Dis. 2019 Oct;34(10):1805-1808. doi: 10.1007/s00384-019-03383-2. Epub 2019 Aug 30.
Although pneumatosis cystoides intestinalis (PCI) is observed in patients who are on corticosteroid treatment, most patients have underlying diseases requiring long-term corticosteroid treatment. Herein, we present a rare case of a patient with aseptic meningitis who had PCI of the ascending colon while receiving betamethasone treatment.
A 46-year-old man was sent to our institution due to disturbance in consciousness and general weakness. Brain computed tomography (CT) scan showed multiple hyperdense lesions over the bilateral hemisphere at the white-gray matter junction. Empiric antibiotic treatment with vancomycin and ceftriaxone was prescribed. Due to acute generalized exanthematous pustulosis (AGEP), we ordered betamethasone and diphenhydramine. Two days later, the patient had bloating and abdominal tenderness. Moreover, contrast-enhanced abdominal CT scan revealed PCI of the ascending colon. Since ischemic bowel disease was suspected, laparoscopy and colonoscopy were carried out. However, no abnormal mucosa or mass lesion was noted. Then, tachycardia, hypotension, and change in consciousness along with loss of brainstem reflex and increased intracranial pressure were noted. After further treatment, the patient's condition worsened, and he eventually died.
As the outcomes of PCI range from benign to life-threatening, an accurate diagnosis must be made to prevent unnecessary abdominal surgeries. Benign PCI in a patient without PCI correlated to underlying diseases, but received short-term corticosteroid treatment should be considered.
虽然在接受皮质类固醇治疗的患者中观察到肠气囊肿症（PCI），但大多数患者患有需要长期皮质类固醇治疗的基础疾病。在此，我们报告了一例接受倍他米松治疗时发生升结肠 PCI 的无菌性脑膜炎患者的罕见病例。
一名 46 岁男性因意识障碍和全身无力被送往我院。脑计算机断层扫描（CT）显示双侧大脑半球灰白质交界处有多个高密度病变。给予万古霉素和头孢曲松经验性抗生素治疗。由于急性泛发性发疹性脓疱病（AGEP），我们开了倍他米松和苯海拉明。两天后，患者出现腹胀和腹痛。此外，增强腹部 CT 扫描显示升结肠 PCI。由于怀疑缺血性肠病，进行了腹腔镜检查和结肠镜检查。然而，未发现异常黏膜或肿块病变。随后，患者出现心动过速、低血压以及意识改变，同时伴有脑干反射消失和颅内压增高。进一步治疗后，患者病情恶化，最终死亡。
由于 PCI 的结果从良性到危及生命不等，必须做出准确的诊断，以避免不必要的腹部手术。在没有与 PCI 相关的基础疾病但接受短期皮质类固醇治疗的患者中，应考虑良性 PCI。
