ao-128 and Pneumatosis-Cystoides-Intestinalis

We report a patient with neuropsychiatric systemic lupus erythematosus (NPSLE) complicated by diabetes mellitus (DM) who showed pneumatosis cystoides intestinalis (PCI) while being treated with prednisolone (PSL) and an alpha-glucosidase inhibitor (αGI). The PCI was ameliorated with the cessation of the αGI and tapering of PSL in addition to transient fasting. Multiple factors, including NPSLE, DM, and medications, may have been involved in the pathogenesis of PCI in this patient.

Topics: Diabetes Complications; Drug Therapy, Combination; Glucocorticoids; Humans; Hypoglycemic Agents; Inositol; Lupus Vasculitis, Central Nervous System; Male; Middle Aged; Pneumatosis Cystoides Intestinalis; Prednisolone; Sulfonylurea Compounds; Tomography, X-Ray Computed

A 69-year-old man was diagnosed as having myasthenia gravis (MG) in September 2004, and treated with thymectomy and prednisolone. He was then diagnosed as having steroid-induced diabetes mellitus, and received sulfonylurea (SU) therapy in May 2005. An alpha-glucosidase inhibitor (alphaGI) was added in March 2006, resulting in good glycemic control. He experienced symptoms of abdominal distention, increased flatus, and constipation in October 2007, and was admitted into our hospital in late November with hematochezia. Plain abdominal radiography revealed small linear radiolucent clusters in the wall of the colon. Computed tomography (CT) showed intramural air in the sigmoid colon. Colonoscopy revealed multiple smooth surfaced hemispherical protrusions in the sigmoid colon. The diagnosis of pneumatosis cystoides intestinalis (PCI) was made on the basis of these findings. As the alphaGI voglibose was suspected as the cause of this patient's PCI, treatment was conservative, ceasing voglibose, with fasting and fluid supplementation. The patient progressed well, and was discharged 2 wk later. Recently, several reports of PCI associated with alphaGI therapy have been published, predominantly in Japan where alphaGIs are commonly used. If the use of alphaGIs becomes more widespread, we can expect more reports of this condition on a global scale. The possibility of PCI should be considered in diabetic patients complaining of gastrointestinal symptoms, and the gastrointestinal tract should be thoroughly investigated in these patients.

Topics: Aged; Diabetes Mellitus; Glycoside Hydrolase Inhibitors; Humans; Hypoglycemic Agents; Inositol; Male; Pneumatosis Cystoides Intestinalis

We describe a 53-year-old patient with dermatomyositis, who developed pneumatosis intestinalis (PI) accompanied by pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema of the neck. The development of PI in our patient was possibly attributed to the effect of factors such as dermatomyositis, corticosteroids, methotrexate, and alpha-glucosidase inhibitor (AGI). The coexistence of multiple factors associated with PI might enhance the risk of developing PI, even though each of them alone is not sufficient to induce it. In particular, the use of AGIs for patients treated with immunosuppressive agents such as corticosteroids requires evaluation.

Topics: Adrenal Cortex Hormones; Dermatomyositis; Female; Humans; Hypoglycemic Agents; Inositol; Middle Aged; Oxygen Inhalation Therapy; Pneumatosis Cystoides Intestinalis

Detailed imaging studies of gas cysts in the intestinal mucosa (pneumatosis cystoides intestinalis) have been reported in around 20 patients taking acarbose, miglitolor voglibose, i.e. intestinal alpha-glucosidase inhibitors used as hypoglycaemic agents. Almost all the patients had nonspecific abdominal symptoms such as abdominal pain, abdominal distension, rectal bleeding or loss of appetite. They underwent multiple diagnostic tests before a role of the drug was raised. The disorders resolved completely when the drugs were withdrawn. In practice, as acarbose and miglitol have no proven impact on morbidity or mortality, and as they have multiple adverse effects, including gas cysts, they should not be used to treat diabetic patients.

Topics: 1-Deoxynojirimycin; Acarbose; Aged; Aged, 80 and over; alpha-Glucosidases; Enzyme Inhibitors; Female; Gases; Glycoside Hydrolase Inhibitors; Humans; Hypoglycemic Agents; Inositol; Intestinal Mucosa; Male; Middle Aged; Pneumatosis Cystoides Intestinalis; Predictive Value of Tests; Risk Assessment; Risk Factors

A 56-year-old woman was admitted to our hospital for treatment of non-specific interstitial pneumonitis (NSIP). The patient started prednisone treatment, but one month later treatment with voglibose, an alpha-glucosidase inhibitor (alpha-GI), was started because of prednisone-induced diabetes mellitus. One week later, a massive volume of free air below the diaphragm was detected by a chest X-ray examination. An abdominal CT examination demonstrated pneumatosis coli and the patient was diagnosed with pneumatosis cystoides intestinalis (PCI). Voglibose was discontinued and parenteral nutrition and oxygen inhalation were initiated. Radiographic findings of PCI disappeared within 7 days. We encountered a rare case of PCI, that was associated with alpha-GI treatment.

Topics: Diabetes Mellitus; Enzyme Inhibitors; Female; Glucocorticoids; Glucosidases; Humans; Hypoglycemic Agents; Inositol; Lung Diseases, Interstitial; Middle Aged; Pneumatosis Cystoides Intestinalis; Prednisone

Topics: Enzyme Inhibitors; Glycoside Hydrolase Inhibitors; Humans; Inositol; Male; Middle Aged; Pneumatosis Cystoides Intestinalis

Topics: Enzyme Inhibitors; Female; Glycoside Hydrolase Inhibitors; Humans; Hypoglycemic Agents; Inositol; Middle Aged; Pneumatosis Cystoides Intestinalis