[Pneumatosis coli--a rare complication of cytostatic therapy]

Recurring paroxysmal abdominal pain developed in a 19-year old woman suffering from acute lymphatic T-cell leukaemia, during induction chemotherapy with cyclophosphamide, cytarabine and mercaptopurine. Both the plain radiograph and CT of the abdomen showed pathognomonic intramural gas accumulations and free air below the right diaphragm, pointing to pneumatosis coli. There was marked pancytopenia (leucocytes 800/microliters,haemoglobin 7.6 g/dl, thrombocytes 10,000/microliters). Whereas the abdominal pain subsided rapidly under oxygen therapy and liquid nourishment, the radiological changes receded gradually. However, fever and diarrhoeas occurred subsequently. Fever persisted for 3 weeks despite treatment with antibiotics (three times 60 mg/d gentamicin, three times 2 g/d mefoxitin and three times 500 mg/d metronidazole, and later 30 mg/d amphotericin B) and subsided only after completion of the induction chemotherapy and an increase of leucocyte count.