PNEUMATOSIS INTESTINALIS (PI) IN BONE MARROW TRANSPLANT (BMT) PATIENTS

Abstract

Pneumatosis intestinalis (PI) is characterized by accumulations of intramural gas along the gastrointestinal tract. Three patients developed PI after allogeneic BMT. A 6 yr old boy with acute non-lymphocytic leukemia received busulfan (BU) and cyclophosphamide (CY) prior to BMT from his HLA-identical sister. He developed acute graft-versus-host disease (AGVHD) and was on prednisone. On day 63 post BMT he developed melena, and PI was noted on abdominal x-ray (AXR). Blood culture was positive for Hafnia alveoli and stool culture grew Candida krusei and Escherichia coli. An 8 yr old boy with acute lymphocytic leukemia received BMT from his sister after CY and total body irradiation. He was treated for severe AGVHD with prednisone and cyclosporine. Abdominal tenderness and PI were noted 52 days post BMT; stools were positive for E. coli, rotavirus and adenovirus. A 4 yr old girl with severe aplastic anemia was treated with androgens, antilymphocyte globulin, and haploidentical parental marrow infusion. Eighteen mos post BMT she had abdominal pain and tenderness; AXR showed colonic PI. Blood and stool cultures were negative. All patients received systemic antibiotics and "nothing by mouth" for 10-14 days. PI resolved within 5-13 days after onset. PI may occur in the profoundly immunocompromised state after BMT; AGVHD and/or viral or bacterial pathogens may be contributory or complicating factors. With conservative therapy, PI has had a good outcome in these patients.

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