Acarbose-Induced Pneumatosis Cystoides Intestinalis

This report details a case of acarbose-induced pneumatosis cystoides intestinalis (PCI) in a 47-year-old man with type 2 diabetes mellitus. The patient presented with a 1-month history of abdominal pain, bloating, and intermittent diarrhea, symptoms that developed after initiating acarbose, an α-glucosidase inhibitor, for diabetes management. Abdominal computed tomography (CT) revealed characteristic features of PCI, including gas-filled cysts within the right colonic wall and free intraperitoneal gas. Notably, laboratory investigations showed no signs of infection, and other findings were unremarkable. Following the discontinuation of acarbose, initiation of a fasting regimen, and short-term metronidazole, the patient's symptoms significantly improved. His blood glucose levels were subsequently managed with repaglinide. A follow-up CT scan 2 months later confirmed the complete resolution of intramural air. This case highlights PCI as a rare but important complication associated with α-glucosidase inhibitors. Prompt recognition, withdrawal of the causative agent, and conservative management are crucial for achieving favorable outcomes. This report further underscores the critical need for increased awareness of PCI in patients receiving α-glucosidase inhibitors and emphasizes the broader importance of pharmacovigilance in identifying rare adverse drug reactions. Further research is warranted to elucidate the precise causal relationship and to explore potential preventive strategies.