A case of 13-year-old girl with acute myeloid leukemia who developed Ogilvie syndrome (acute colonic pseudo-obstruction) and posterior reversible encephalopathy syndrome due to generalized herpes zoster after completion of chemotherapy

Abstract

Ogilvie syndrome, also called acute colonic pseudo-obstruction, is a rare disorder characterized by abrupt and progressive colonic dilatation without mechanical obstruction. We report the case of a 13-year-old girl who complained of severe abdominal pain and constipation two months after the completion of chemotherapy for acute myeloid leukemia. She presented with marked bowel distention, impaired consciousness, and generalized blisters with crust formation. Abdominal computed tomography and brain magnetic resonance imaging showed marked colonic dilatation and a high-intensity area in the occipital lobe, respectively, on T2-weighted images. On the basis of these findings, Ogilvie syndrome and reversible posterior leukoencephalopathy syndrome resulting from generalized herpes zoster were diagnosed. The patient was treated successfully by the administration of acyclovir, neostigmine, dexamethasone, and glycerol and by transanal tube decompression. Immunological recovery after the completion of leukemia treatment takes several months. Therefore, patients should be cautiously monitored keeping in mind the possibility of severe infectious complications even after the completion of chemotherapy.