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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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Combination therapy for systemic sclerosis-associated pneumatosis intestinalis.

Kanyada Koysombat1, Maria Vittoria Capanna1, Nina Stafford1

  • 1Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK.

BMJ Case Reports
|July 14, 2018
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Summary

Systemic sclerosis can cause pneumatosis intestinalis, a rare condition. This case shows successful medical management using antibiotics, an elemental diet, and oxygen therapy, avoiding surgery.

Keywords:
antibiotic therapyconnective tissue diseaseelemental dietenteric microfloraoxygen therapypneumatosis intestinalissystemic sclerosis

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Area of Science:

  • Gastroenterology
  • Rheumatology
  • Radiology

Background:

  • Systemic sclerosis is a multisystem autoimmune disease.
  • Gastrointestinal involvement is common but pneumatosis intestinalis is a rare complication.
  • Management of pneumatosis intestinalis in systemic sclerosis lacks established guidelines.

Observation:

  • A patient with gastrointestinal systemic sclerosis presented with abdominal pain.
  • The patient was diagnosed with pneumatosis intestinalis and pneumoperitoneum.
  • Recurrent emergency attendances indicated a need for effective management.

Findings:

  • Successful medical management was achieved with a combination of antimicrobial therapy, elemental diet, and high-flow oxygen.
  • Computed tomography (CT) imaging confirmed the resolution of pneumatosis intestinalis and pneumoperitoneum.
  • This represents the first reported case of symptomatic and radiological improvement with this combination therapy without surgical intervention.

Implications:

  • This case highlights a potential non-surgical treatment strategy for pneumatosis intestinalis in systemic sclerosis.
  • The findings may inform future clinical practice and research into managing this rare complication.
  • Further investigation is warranted to validate this therapeutic approach in a larger cohort.