title: Pneumatosis intestinalis and portal venous gas secondary to Gefitinib therapy for lung adenocarcinoma.
abstract: BACKGROUND
  Pneumatosis intestinalis (PI), defined as the presence of gas in the bowel wall, and portal venous gas (PVG) are relatively rare radiological findings. Although several chemotherapeutic agents and anti-vascular endothelial growth factor agents are reported to be associated with PI and PVG, an association with anti-epidermal growth factor receptor (EGFR) agents has not been described previously.
  
  
  METHODS
  The present report describes a case of PI and PVG secondary to treatment with an EGFR tyrosine kinase inhibitor. A 66-year-old woman who had been diagnosed with metastatic lung adenocarcinoma presented with nausea, vomiting and abdominal distension after commencing gefitinib. A computed tomography (CT) scan of the abdomen revealed PI extending from the ascending colon to the rectum, hepatic PVG, and infarction of the liver. Gefitinib therapy was discontinued immediately and the patient was managed conservatively. A follow-up CT scan 2 weeks later revealed that the PI and hepatic PVG had completely resolved.
  
  
  CONCLUSIONS
  This is the first report of PI and PVG caused by EGFR tyrosine kinase inhibitor. Although these complications are extremely rare, clinicians should be aware of the risk of PI and PVG in patients undergoing targeted molecular therapy.
authors.affiliation: Department of Internal Medicine College of Medicine, Chungbuk National University, 410 Seongbong-ro, Heungduk-Gu, Cheongju 361-711, South Korea.
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Hye-Suk
authors.initials: HS
authors.lastname: Han
authors.forename: Sung-Nam
authors.initials: SN
authors.lastname: Lim
authors.forename: Young Kwang
authors.initials: YK
authors.lastname: Shim
authors.forename: Yong Hyeok
authors.initials: YH
authors.lastname: Choi
authors.forename: Ok-Jun
authors.initials: OJ
authors.lastname: Lee
authors.forename: Ki Hyeong
authors.initials: KH
authors.lastname: Lee
authors.forename: Seung Taik
authors.initials: ST
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000368:Aged; D004618:Embolism, Air / Q000139:chemically induced*; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D011006:Pneumatosis Cystoides Intestinalis / Q000139:chemically induced*; D011169:Portal Vein; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011799:Quinazolines / Q000009:adverse effects*
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000077156:Gefitinib