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Pneumatosis intestinalis in children after allogeneic bone marrow transplantation

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Abstract

Four children, ages 3 to 8 years, developed pneumatosis intestinalis (PI) after allogeneic bone marrow transplantation (BMT) for acute leukemia or severe aplastic anemia. PI was detected at a median of 48 days (range, 10–63 days) after BMT and was associated with abdominal symptoms and clinical signs. All patients had severe systemic and/or high-grade cutaneous acute graft-versus-host disease (AGVHD) at some time after BMT and were receiving corticosteroids at the time of development of PI; however, PI was associated with concomitant severe AGVHD in only one patient. One patient with PI hadHafnia alvei bacteremia and another patient had gastroenteritis due to rotavirus and adenovirus. All patients were treated with supportive care and systemic broad-spectrum antibiotics, and PI resolved 2–16 days after onset. Two patients died with BMT-associated complications unrelated to PI. Multiple factors contribute to the development of PI after BMT, and the prognosis for recovery from PI is good with medical management alone. Overall survival in these patients is dependent on the frequency and severity of other conditions, such as AGVHD and opportunistic infections, after BMT.

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References

  1. Ecker JA, Williams RG, Clay KL (1971) Pneumatosis cystoides intestinalis — bullous emphysema of the intestine. Am J Gastroenterol 56: 125

    CAS  PubMed  Google Scholar 

  2. Marshak RH, Lindner AE, Milano AM (1971) Pneumatosis coli. Am J Gastroenterol 56: 68

    CAS  PubMed  Google Scholar 

  3. Vichi GF, Maggini M, Moggi P, Gori F, Paoli F (1973) Pneumatosis intestinalis in infants: clinical, radiological, and anatomopathological study on eighteen patients. Ann Radiol 16: 153

    Google Scholar 

  4. Wood RE, Herman CJ, Johnson KW, di Sant'Agnese PA (1975) Pneumatosis coli in cystic fibrosis. Am J Dis Child 129: 246

    CAS  PubMed  Google Scholar 

  5. Mueller C, Morehead R, Alter A, Michener W (1972) Pneumatosis intestinalis in collagen disorders. Am J Roentgenol 115: 300

    CAS  Google Scholar 

  6. Oliveros M, Herbst J, Lester P, Ziter F (1973) Pneumatosis intestinalis and childhood dermatomyositis. Pediatrics 52: 711

    CAS  PubMed  Google Scholar 

  7. Braunstein EM, White SJ (1980) Pneumatosis intestinalis in dermatomyositis. Br J Radiol 53: 1011

    CAS  PubMed  Google Scholar 

  8. Jaffe N, Carlson DH, Vawter GF (1972) Pneumatosis cystoides intestinalis in acute leukemia. Cancer 30: 239

    CAS  PubMed  Google Scholar 

  9. Borns PF, Johnston TA (1973) Indolent pneumatosis of the bowel wall associated with immune suppressive therapy. Ann Radiol 16: 163

    Google Scholar 

  10. Keats TE, Smith TH (1974) Benign pneumatosis intestinalis in childhood leukemia. Am J Roentgenol Radium Ther Nucl Med 122: 150

    CAS  PubMed  Google Scholar 

  11. Galal O, Osse G, Weigel W, Gahr M (1981) Pneumatosis intestinalis in children with leukaemia: report of three cases. Eur J Pediatr 137: 91

    Article  CAS  PubMed  Google Scholar 

  12. Miholic J, Kummer M (1983) Pneumatosis intestinalis in childhood leukaemia: report of a case with gas in the portal vein and review of the literature. Helv Paediatr Acta 38: 533

    CAS  PubMed  Google Scholar 

  13. Braver JM, Horrow MM, Philipps E (1984) Leukemic intestinal pneumatosis. J Can Assoc Radiol 35: 80

    CAS  PubMed  Google Scholar 

  14. Kleinman PK, Brill PW, Winchester P (1980) Pneumatosis intestinalis: its occurrence in the immunologically compromised child. Am J Dis Child 134: 1149

    CAS  PubMed  Google Scholar 

  15. Wall LL, Linshaw MA, Bailie MD, Pierce GE (1982) Pneumatosis intestinalis in a pediatric renal transplant patient. J Pediatr 101: 745

    CAS  PubMed  Google Scholar 

  16. Navari RM, Sharma P, Deeg HJ, McDonald GB, Thomas ED (1983) Pneumatosis cystoides intestinalis following allogeneic marrow transplantation. Transplant Proc 15: 1720

    CAS  PubMed  Google Scholar 

  17. Santos GW, Tutschka PJ, Brookmeyer R, et al. (1983) Marrow transplantation for acute nonlymphocytic leukemia after treatment with busulfan and cyclophosphamide. N Engl J Med 309: 1347

    CAS  PubMed  Google Scholar 

  18. Glucksberg H, Storb R, Fefer A, et al. (1974) Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 18: 295

    CAS  PubMed  Google Scholar 

  19. Slavin RE, Santos GW (1973) The graft-versus-host reaction in man after bone marrow transplantation: pathology, pathogenesis, clinical features, and implication. Clin Immunol Immunopathol 1: 472

    Article  CAS  PubMed  Google Scholar 

  20. Santos GW, Bias WB, Beschorner WE, et al. (1983) Allogeneic and syngeneic marrow transplantation for acute lymphocytic leukemia (ALL) in remission — Baltimore experience. Exp Hematol 11 (Suppl 14): 132 [Abstract]

    Google Scholar 

  21. Speck B, Gluckman E, Haak HL, Van Rood JJ (1977) Treatment of aplastic anaemia by antilymphocyte globulin with and without allogeneic bone-marrow infusions. Lancet 2: 1145

    CAS  PubMed  Google Scholar 

  22. McCarthy D, Holland I, Lavender JP, Catovsky D (1979) Pneumatosis coli in adult acute myeloid leukaemia. Clin Radiol 30: 175

    Article  CAS  PubMed  Google Scholar 

  23. O'Connell DJ, Thompson AJ (1978) Pneumatosis coli in non-Hodgkin's lymphoma. Br J Radiol 51: 203

    PubMed  Google Scholar 

  24. Shindelman LE, Geller SA, Wisch N, Bauer JJ (1981) Pneumatosis cystoides intestinalis: a complication of systemic chemotherapy. am J Gastroenterol 75: 270

    CAS  PubMed  Google Scholar 

  25. Kleinman P, Meyers MA, Abbott G, Kazam E (1976) Necrotizing enterocolitis with pneumatosis intestinalis in systemic lupus erythematosus and polyarteritis. Radiology 121: 595

    CAS  PubMed  Google Scholar 

  26. Derksen OS (1978) Pneumatosis intestinalis in a female patient with systemic lupus erythematosus. Radiol Clin 47: 334

    CAS  Google Scholar 

  27. Koep LJ, Peters TG, Starzl TE (1979) Major colonic complications of hepatic transplantation. Dis Col Rect 22: 218

    CAS  Google Scholar 

  28. Smith BH, Welter LH (1967) Pneumatosis intestinalis. Am J Clin Path 48: 455

    CAS  PubMed  Google Scholar 

  29. Gupta A (1978) Pneumatosis intestinalis in children. Br J Radiol 51: 589

    CAS  PubMed  Google Scholar 

  30. Townsend TR, Bolyard EA, Yolken RH, et al. (1982) Outbreak of Coxsackie A1 gastroenteritis: a complication of bone-marrow transplantation. Lancet I: 820

    Google Scholar 

  31. Yolken RH, Bishop CA, Townsend TR, et al. (1982) Infectious gastroenteritis in bone-marrow transplant recipients. N Engl J Med 306: 1009

    Google Scholar 

  32. Lubitz L, Ekert H (1979) Reversible changes in duodenal mucosa associated with intensive chemotherapy followed by autologous marrow rescue. Lancet 2: 532

    CAS  PubMed  Google Scholar 

  33. Epstein RJ, McDonald GB, Sale GE, Shulman HM, Thomas ED (1980) The diagnostic accuracy of the rectal biopsy in acute graft-versus-host disease: a prospective study of thirteen patients. Gastroenterology 78: 764

    CAS  PubMed  Google Scholar 

  34. Slavin RE, Dias MA, Saral R (1978) Cytosine-arabinoside induced gastrointestinal toxic alterations in sequential chemotherapeutic protocols: a clinical-pathological study of 33 patients. Cancer 42: 1747

    CAS  PubMed  Google Scholar 

  35. Forgacs P, Wright PH, Wyatt AP (1973) Treatment of intestinal gas cyst by oxygen breathing. Lancet 1: 579

    CAS  PubMed  Google Scholar 

  36. Connor R, Jones B, Fishman EK, Siegelman SS (1984) Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comput Assist Tomogr 8: 269

    CAS  PubMed  Google Scholar 

  37. Kelvin FM, Korobkin M, Rauch RF, Rice RP, Silverman PM (1984) Computed tomography of pneumatosis intestinalis. J Comput Assist Tomogr 8: 276

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Oncology Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    A. M. Yeager, R. Saral & G. W. Santos

  2. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    R. Saral & G. W. Santos

  3. Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    A. M. Yeager, M. E. Kanof, S. S. Kramer & A. M. Lake

  4. Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    S. S. Kramer & B. Jones

  5. Johns Hopkins Oncology Center, 600 North Wolfe Street, 21205, Baltimore, USA

    A. M. Yeager

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  1. A. M. Yeager
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  2. M. E. Kanof
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  3. S. S. Kramer
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  4. B. Jones
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  5. R. Saral
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  6. A. M. Lake
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  7. G. W. Santos
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Yeager, A.M., Kanof, M.E., Kramer, S.S. et al. Pneumatosis intestinalis in children after allogeneic bone marrow transplantation. Pediatr Radiol 17, 18–22 (1987). https://doi.org/10.1007/BF02386589

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  • DOI: https://doi.org/10.1007/BF02386589

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