title: Intestinal Pneumatosis Associated with Tuberculosis after Allogeneic Hematopoietic Stem Cell Transplantation.
abstract: Pneumatosis intestinalis (PI), defined as intestinal intra- and extramural gas accumulation, is a rare radiographic finding in conditions of intestinal wall damage of varied etiology. Here, we report on a 56-year-old female with multiple myeloma who presented with undulating fever, fluctuating abdominal symptoms, and a distended abdomen 5 months after allogeneic hematopoietic stem cell transplantation (HSCT). Abdominal X-ray and CT scan documented PI with gas accumulation both in the intestinal and colonic bowel walls. Concurrently, thoracic CT revealed mediastinal and bihilar lymphadenopathy associated with bilateral pleural effusions. Microscopy of bronchoalveolar lavage fluid (BALF) revealed acid-fast bacilli, which were identified as Mycobacterium tuberculosis. Tuberculostatic treatment resulted in timely clinical improvement, a complete clearance of the radiological and clinical findings of PI, and the control of the tuberculosis (Tbc), determined by multiple negative BALF results. Taken together, PI occurred as the initial symptom of Tbc in an allogeneic stem cell recipient, achieving complete recovery by tuberculostatic treatment only.
authors.affiliation: Department of Hematology and Medical Oncology, University Medicine Göttingen, Göttingen, Germany.
authors.forename: Vivek
authors.initials: V
authors.lastname: Venkataramani
authors.forename: Ali
authors.initials: A
authors.lastname: Seif Amir Hosseini
authors.forename: Marco H
authors.initials: MH
authors.lastname: Schulze
authors.forename: Lorenz
authors.initials: L
authors.lastname: Trümper
authors.forename: Gerald
authors.initials: G
authors.lastname: Wulf
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jung
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D012293:Rifampin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin