Pneumatosis intestinalis associated with immune-suppressive agents in a case of minimal change disease

Area of Science:

• Nephrology
• Gastroenterology

Background:

• Minimal change disease (MCD) is a common cause of nephrotic syndrome.
• Immunosuppressive therapy, including steroids, is the mainstay of MCD treatment.
• Pneumatosis intestinalis (PI) is a rare but serious complication of immunosuppression.

Observation:

• A 38-year-old male patient with steroid-resistant MCD developed PI during immunosuppressive treatment.
• Radiological findings confirmed extensive air accumulation in the bowel, peritoneum, mediastinum, and retroperitoneum.
• Clinical and laboratory findings were otherwise unremarkable.

Findings:

• The patient's PI, a rare complication of immunosuppressive agents used for MCD, was successfully managed conservatively.
• Treatment involved oxygen supplementation and metronidazole, leading to symptom improvement.
• This represents the second reported case of PI in a patient with nephrotic syndrome and the first case reported in English literature.

Implications:

• This case highlights the potential for PI as a rare adverse effect of immunosuppressive therapy in patients with MCD.
• Conservative management may be effective for PI in this context.
• Increased awareness among clinicians is warranted for early diagnosis and management of PI in patients with nephrotic syndrome undergoing immunosuppression.