[A case report of chronic intestinal pseudo-obstruction with autoimmune autonomic ganglionopathy suspected from seropositive results for anti-ganglionic acetylcholine receptor antibody].
A 37-year-old woman who had previously been diagnosed with idiopathic chronic intestinal pseudo-obstruction (CIPO) at another hospital was admitted to our institution with severe abdominal pain. She had a history of several abdominal surgeries to treat ileus at the previous hospital, and contrast-enhanced computed tomography on admission revealed subileus without any apparent causes of obstruction. Total parenteral nutrition, a gastrointestinal prokinetic agent, and opiates reduced persistent pain;however, breakthrough pain continued. A neurologist at our hospital suggested autoimmune autonomic ganglionopathy (AAG) as a potential cause of CIPO. The patient was diagnosed with suspected AAG on the basis of seropositive results for anti-ganglionic acetylcholine receptor antibody. Intravenous immunoglobulin administration and plasma exchange were performed in combination with immunosuppressive drugs;however, her symptoms barely improved. Although percutaneous endoscopic gastrostomy and enterostomy were subsequently performed to reduce internal intestinal pressure, her pain relief was insufficient.
Second Department of Internal Medicine, Wakayama Medical University.
Koki
K
Kawanishi
Kosaku
K
Moribata
Jun
J
Kato
Kenya
K
Murata
Kazuhiro
K
Fukatsu
Hidehiko
H
Tamaki
Daisaku
D
Itou
Yuki
Y
Wada
Masao
M
Ichinose
D000328:Adult; D001323:Autoantibodies / Q000097:blood* / Q000276:immunology; D020274:Autoimmune Diseases of the Nervous System / Q000150:complications* / Q000276:immunology / Q000378:metabolism; D005260:Female; D040181:Genetic Diseases, X-Linked / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology*; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000151:congenital* / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D011950:Receptors, Cholinergic / Q000276:immunology*; D014057:Tomography, X-Ray Computed
D001323:Autoantibodies; D011950:Receptors, Cholinergic