title: Intestinal pseudo-obstruction in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) associated with phenytoin therapy.
abstract: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is most commonly associated with a mitochondrial DNA A to G point mutation at nucleotide 3243 (A3243G) and individuals with the disorder present a wide range of multisystemic symptoms. Seizures in MELAS patients are often intractable and require multiple antiepileptic drugs. Here we report a MELAS patient who presented with acute intestinal pseudo-obstruction following the administration of phenytoin (PHT) as an antiepileptic treatment. She presented with the first stroke-like episode at the age of 6 years and mitochondrial DNA analysis revealed A3243G with 94% mutation load in skeletal muscle. Despite treatment with phenobarbital and clobazam at the age of 16 years, she developed status epilepticus which ceased following PHT infusion. Thereafter, she was started on PHT treatment. One month later, however, she was readmitted because of remarkable abdominal distention. Although abdominal CT showed acute ileus with hepatic portal venous gas mimicking surgical emergency, the abdominal distention gradually recovered over several days following the discontinuation of PHT. Our clinical observations suggest the possibility that intestinal pseudo-obstruction in this patient related to PHT therapy. Careful clinical observation including gastrointestinal symptoms is required in the management of epilepsy in MELAS patients.
authors.affiliation: Department of Pediatrics, Akashi Municipal Hospital, 1-33 Takasho-machi, Akashi, Hyogo 673-8501, Japan. chiyonobu@kobe.zaq.jp
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Chiyonobu
authors.forename: Rei
authors.initials: R
authors.lastname: Noda
authors.forename: Michiko
authors.initials: M
authors.lastname: Yoshida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujiki
authors.forename: Rumiko
authors.initials: R
authors.lastname: Ishii
authors.forename: Sadayuki
authors.initials: S
authors.lastname: Nukina
authors.forename: Kinya
authors.initials: K
authors.lastname: Fujita
authors.forename: Yu-ichi
authors.initials: Y
authors.lastname: Goto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Morimoto
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000139:chemically induced* / Q000473:pathology; D017241:MELAS Syndrome / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D010672:Phenytoin / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin