title: Pneumatosis intestinalis during chemotherapy with nilotinib in a patient with chronic myeloid leukemia who tested positive for anti-topoisomerase I antibodies.
abstract: A 55-year-old man with several comorbidities including idiopathic interstitial pneumonia under long-term corticosteroid therapy, longstanding myocardial infarction, chronic heart failure, paroxysmal atrial fibrillation, gastro-esophageal reflux disease, constipation, and history of paralytic ileus, was diagnosed with chronic myelogenous leukemia (CML) in the chronic phase. He also tested positive for anti-topoisomerase I antibodies without clinical diagnosis of any connective tissue disease, including systemic sclerosis. Approximately 5 months after the initiation of nilotinib for CML, he developed upper abdominal distension with intermitting abdominal pain, and based on abdominal computed tomography findings, a diagnosis of pneumatosis intestinalis (PI) was made. Five courses of hyperbaric oxygen therapy quickly eliminated the PI and related symptoms without the cessation of nilotinib and, thereafter, additional oral prokinetic agents and non-absorbable antibiotics ensured the non-recurrence of PI. At 6 and 18 months after commencing nilotinib therapy, major and complete molecular response were achieved, respectively. It is suspected that both gastrointestinal hypokinesis related to the presence of anti-topoisomerase I antibodies and mucosal permeability due to corticosteroid therapy had existed. Thus, subsequent administration of nilotinib may have triggered PI by depressing gastrointestinal motility via the inhibition of c-kit.
authors.affiliation: Department of Hematology, Sapporo Kiyota Hospital, 1-1-1-1 Shin-ei, Kiyota ward, Sapporo, 004-0831, Japan. akihito.fujimi@gmail.com.
authors.forename: Akihito
authors.initials: A
authors.lastname: Fujimi
authors.affiliation: Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Department of Hematology and Oncology, Oji General Hospital, Tomakomai, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kanisawa
authors.affiliation: Department of Gastroenterology, Oji General Hospital, Tomakomai, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Minami
authors.affiliation: Department of Hematology, Sapporo Kiyota Hospital, 1-1-1-1 Shin-ei, Kiyota ward, Sapporo, 004-0831, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nagamachi
authors.affiliation: Department of Hematology, Sapporo Kiyota Hospital, 1-1-1-1 Shin-ei, Kiyota ward, Sapporo, 004-0831, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Yamauchi
authors.affiliation: Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Soushi
authors.initials: S
authors.lastname: Ibata
authors.affiliation: Department of Medical Oncology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Kato
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood*; D004264:DNA Topoisomerases, Type I / Q000276:immunology*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000276:immunology; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D001323:Autoantibodies; D011743:Pyrimidines; D004264:DNA Topoisomerases, Type I; C498826:nilotinib
keywords: Anti-topoisomerase I antibodies; Chronic myeloid leukemia; Nilotinib; Pneumatosis intestinalis