A 69-year-old man was diagnosed as having
myasthenia gravis (MG) in September 2004, and treated with
thymectomy and
prednisolone. He was then diagnosed as having
steroid-induced
diabetes mellitus, and received sulfonylurea (SU)
therapy in May 2005. An
alpha-glucosidase inhibitor (alphaGI) was added in March 2006, resulting in good
glycemic control. He experienced symptoms of abdominal distention, increased
flatus, and
constipation in October 2007, and was admitted into our hospital in late November with
hematochezia. Plain abdominal radiography revealed small linear radiolucent clusters in the wall of the colon. Computed tomography (CT) showed intramural air in the sigmoid colon. Colonoscopy revealed multiple smooth surfaced hemispherical protrusions in the sigmoid colon. The diagnosis of
pneumatosis cystoides intestinalis (PCI) was made on the basis of these findings. As the alphaGI
voglibose was suspected as the cause of this patient's PCI, treatment was conservative, ceasing
voglibose, with fasting and fluid supplementation. The patient progressed well, and was discharged 2 wk later. Recently, several reports of PCI associated with alphaGI
therapy have been published, predominantly in Japan where alphaGIs are commonly used. If the use of alphaGIs becomes more widespread, we can expect more reports of this condition on a global scale. The possibility of PCI should be considered in diabetic patients complaining of gastrointestinal symptoms, and the gastrointestinal tract should be thoroughly investigated in these patients.