In May 2009, a 57-year-old woman who had
rheumatoid arthritis since 9 years was admitted to our hospital for
dyspnea due to
interstitial pneumonia (IP). On admission, she exhibited proximal scleroderma, finger
edema, Raynaud's phenomenon, digital pitting
scars,
ankyloglossia, and
esophageal dysmotility. The patient was diagnosed as having
systemic sclerosis (SSc), according to the American College of Rheumatology criteria. After initiation of high-dose
corticosteroid therapy, gradual amelioration of IP was observed. However, the patient complained of abdominal fullness. Computed tomography and intestine series findings revealed significant dilatation of the small intestine due to intra-abdominal free air and
pneumatosis cystoides intestinalis but no mechanical obstruction, leading to a diagnosis of SSc with pseudo-obstruction. The patient underwent
decompression with a long intestinal tube, which led to improvement in her symptoms. Although
erythromycin (EM) and some prokinetic agents were administered, abdominal involvement recurred several days after resumption of oral ingestion. Therefore, we changed the
antibiotic from EM to
metronidazole (750 mg/day). Her manifestations were promptly ameliorated by
metronidazole therapy in 4 days and did not recur.
Metronidazole is an
antibiotic used to treat intra-abdominal anaerobic
bacterial infections and is also commonly used in preoperative treatment for colorectal surgery. In conclusion, we report a case where SSc-associated pseudo-obstruction was successfully managed by
metronidazole therapy.