Pneumatosis Cystoides Intestinalis Associated with Rotavirus Gastroenteritis and Syndrome of Inappropriate ADH in a Leukaemic Child

A 21-month old boy with newly diagnosed common acute lymphoblastic leukemia underwent induction chem othera py wi t h p red n iso lo ne, v i ncrist ine, daunorubicin and L-asparaginase according to The Hong Kong Acute Lymphoblastic Leukaemia 1997 Protocol.1 He had bloody d iarrhea during the first two weeks of treatment. Ro tav irus was the only pathogen detected and test fo r the Clost ridium d ifficile cy to toxin was negat ive. Twenty-four hours after receiving the second dose of vincristine in the beginning of the third week of treatment, the child suddenly developed status epilepticus and a progressive abdominal distention. There was no localising or lateralising neurological sign and fundoscopy did not reveal any papilloedema or bleeding. Diffuse abdominal Abstract A 21-month-old boy with newly diagnosed acute lymphoblastic leukaemia had Rotavirus gastroenteritis during the first two weeks of induction chemotherapy. During the third week of treatment, he developed status epilepticus and progressive abdominal distention simultaneously. The former was precipitated by severe hyponatraemia associated vincristine induced syndrome of inappropriate anti-diuretic hormone. Typical radiological features of pneumatosis cystoides intestinalis were also recognised with the presence of free intra-abdominal gas. Despite the signs of an acute abdomen, an exploratory laparotomy did not reveal any bowel perforation. The child eventually recovered on intensive supportive care. Pneumatosis cystoides intestinalis is a rare but significant complication in immunocompromised patients. Laparotomy is usually not beneficial even in the presence of free intra-abdominal gas.