DÄ internationalArchive24/2024Pneumatosis Intestinalis in Metastatic Colon Cancer During Cetuximab Treatment

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Pneumatosis Intestinalis in Metastatic Colon Cancer During Cetuximab Treatment

Dtsch Arztebl Int 2024; 121: 799. DOI: 10.3238/arztebl.m2024.0148

Orlemann, T; Zundler, S; Graetz, T

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Further details on the imaging for this case: Abdominal CT with intravenous and oral contrast in the soft-tissue window. Axial section at the level of L3. New-onset segmental pneumatosis intestinalis of the colon, i.e., air bubbles in the colon wall, was observed in this asymptomatic patient during restaging. On the image, one sees the intramural gas accumulation as a black border (arrow) around the intestinal lumen of the ascending colon.
Figure
Further details on the imaging for this case: Abdominal CT with intravenous and oral contrast in the soft-tissue window. Axial section at the level of L3. New-onset segmental pneumatosis intestinalis of the colon, i.e., air bubbles in the colon wall, was observed in this asymptomatic patient during restaging. On the image, one sees the intramural gas accumulation as a black border (arrow) around the intestinal lumen of the ascending colon.
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A patient in his 50s with metastatic cancer of the descending colon (all-RAS wild-type) who was undergoing treatment with FOLFIRI (folinic acid, 5-FU, irinotecan) in combination with the monoclonal EGF receptor antibody cetuximab showed a significant increase in CRP level without clinical signs of infection during a routine blood test. The search for a focus of infection, including computed tomography of the abdomen, revealed pneumatosis intestinalis (PI) in the ascending and transverse colon. PI can have various causes, among them life-threatening disorders such as mesenteric ischemia, inflammatory bowel disease, and drug side effects. In this particular case, we assume an association between PI and cetuximab treatment to be the most likely. This is extremely rare, with only 10 cases described in the literature to date. Here, it occurred in temporal relation to the administration of the drug; no other causes were found. Cetuximab was temporarily discontinued. Over the following weeks, ultrasound showed complete resolution of the findings, and the patient’s CRP level also returned to normal. Thereafter, cetuximab treatment could be resumed without complications.

Dr. med. Till Orlemann, Prof. Dr. Dr. med. Sebastian Zundler, Medizinische Klinik 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg,Germany, till.orlemann@uk-erlangen.de

Dr. med. Teresa Graetz, Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Orlemann T, Graetz T, Zundler S: Pneumatosis intestinalis in metastatic colon cancer during cetuximab treatment. Dtsch Arztebl Int 2024; 121: 799. DOI: 10.3238/arztebl.m2024.0148

Further details on the imaging for this case: Abdominal CT with intravenous and oral contrast in the soft-tissue window. Axial section at the level of L3. New-onset segmental pneumatosis intestinalis of the colon, i.e., air bubbles in the colon wall, was observed in this asymptomatic patient during restaging. On the image, one sees the intramural gas accumulation as a black border (arrow) around the intestinal lumen of the ascending colon.
Figure
Further details on the imaging for this case: Abdominal CT with intravenous and oral contrast in the soft-tissue window. Axial section at the level of L3. New-onset segmental pneumatosis intestinalis of the colon, i.e., air bubbles in the colon wall, was observed in this asymptomatic patient during restaging. On the image, one sees the intramural gas accumulation as a black border (arrow) around the intestinal lumen of the ascending colon.
Enlarge All figures
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