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Pneumatosis intestinalis in children after allogeneic bone marrow transplantation
Insights
Pneumatosis intestinalis (PI) can occur in children after bone marrow transplantation (BMT). Prompt medical management leads to good recovery from PI, but survival depends on other BMT complications.
Area of Science:
- Pediatric Hematology/Oncology
- Gastroenterology
- Transplantation Medicine
Background:
- Allogeneic bone marrow transplantation (BMT) is a critical treatment for pediatric acute leukemia and severe aplastic anemia.
- Pneumatosis intestinalis (PI), a condition characterized by air in the bowel wall, is a rare but serious complication post-BMT.
- Graft-versus-host disease (GVHD) and immunosuppressive therapy are known risk factors for gastrointestinal complications after BMT.
Observation:
- Four pediatric patients (ages 3-8) developed PI between 10-63 days post-BMT.
- PI onset was associated with abdominal symptoms and clinical signs.
- Patients had a history of severe acute graft-versus-host disease (AGVHD) and were on corticosteroids, though PI was only linked to active severe AGVHD in one case.
Findings:
- One patient had Hafnia alvei bacteremia, and another had rotavirus and adenovirus gastroenteritis.
- All patients received supportive care and broad-spectrum antibiotics, resulting in PI resolution within 2-16 days.
- Two patients died due to unrelated BMT complications, not PI.
Implications:
- Multiple factors contribute to PI development following BMT.
- Prognosis for PI recovery is favorable with appropriate medical management.
- Patient survival post-BMT is primarily influenced by the severity of concurrent conditions like AGVHD and opportunistic infections.
Abstract:
Four children, ages 3 to 8 years, developed pneumatosis intestinalis (PI) after allogeneic bone marrow transplantation (BMT) for acute leukemia or severe aplastic anemia. PI was detected at a median of 48 days (range, 10-63 days) after BMT and was associated with abdominal symptoms and clinical signs. All patients had severe systemic and/or high-grade cutaneous acute graft-versus-host disease (AGVHD) at some time after BMT and were receiving corticosteroids at the time of development of PI; however, PI was associated with concomitant severe AGVHD in only one patient. One patient with PI had Hafnia alvei bacteremia and another patient had gastroenteritis due to rotavirus and adenovirus. All patients were treated with supportive care and systemic broad-spectrum antibiotics, and PI resolved 2-16 days after onset. Two patients died with BMT-associated complications unrelated to PI. Multiple factors contribute to the development of PI after BMT, and the prognosis for recovery from PI is good with medical management alone. Overall survival in these patients is dependent on the frequency and severity of other conditions, such as AGVHD and opportunistic infections, after BMT.