Abstract
Background
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.
Case presentation
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.
Conclusion
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.
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All the data regarding the findings are available within the manuscript.
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Acknowledgments
We thank colleagues at the Department of Radiology and Neurology in our hospital for providing the data and the imaging and treating the patient.
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Nien-Ying Tsai collected data and wrote the manuscript.
Chung-Hsing Chou treated the patient and interpreted the data.
Yi-Chiao Cheng did diagnostic laparoscopy and colonoscopy and was a supervisor.
All the authors read and approved the final manuscript.
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Tsai, NY., Chou, CH. & Cheng, YC. Pneumatosis cystoides intestinalis in a patient with aseptic meningitis: a case report. Int J Colorectal Dis 34, 1805–1808 (2019). https://doi.org/10.1007/s00384-019-03383-2
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DOI: https://doi.org/10.1007/s00384-019-03383-2