Gastric Pneumatosis Due to Immunochemotherapy for Lung Cancer

A female patient in her 60s with progressive lung adenocarcinoma following 12 weeks of immunochemotherapy (carboplatin, paclitaxel, bevacizumab, and atezolizumab) underwent follow-up ultrasound. This revealed extensive submucosal gas in the gastric wall, consistent with gastric pneumatosis (Figure a). The patient experienced no symptoms in this regard. Endoscopy demonstrated extensive gastric ulcerations. Computed tomography confirmed isolated gastric pneumatosis (Figure b)—an unusual manifestation of pneumatosis intestinalis, which is more commonly located in the colon or small intestine. In this case, the antiangiogenic effects of anti-VEGF therapy (bevacizumab) were considered to be the most likely cause; it appeared possible that immune-mediated mucosal injury caused by the checkpoint inhibitor atezolizumab (PD-L1) was also involved. Although pneumatosis is often asymptomatic, life-threatening cases have been described. In view of the overall palliative situation, systemic treatment was discontinued. Radiological follow-up at 10 days demonstrated a significant improvement under proton pump inhibitor and antibiotic therapy. Several months later, the patient was still receiving palliative care.

Figure

High-resolution ultrasound of the gastric wall / Contrast-enhanced coronal CT reconstruction

Willem Töllner, Prof. Dr. med. Jens Walldorf, Dr. med. Valentin Blank, Universitätsklinik für Innere Medizin I, Universitätsklinikum Halle (Saale) [e-mail]

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

Translated from the original German by Christine Rye.

Cite this as: Töllner W, Walldorf J, Blank V: Gastric pneumatosis due to immunochemotherapy for lung cancer. Dtsch Arztebl Int 2025; 122: 566. DOI: 10.3238/arztebl.m2025.0129