Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes

ARTICLE HIGHLIGHTS

Research background

The gastrointestinal tract hosts the body’s most enriched lymphoid tissues and microbial community and therefore can provide sufficient activated immune cells and continuous intestine-derived antigens to influence the host hematopoietic and immune functions. The gastrointestinal tract is the most common site for infectious and inflammatory diseases. Morphological changes on computed tomography (CT) images can provide useful information that reflects the distribution, extent, and severity of the bowel inflammation and even suggests a pathogenic diagnosis.

Research motivation

Initiation and perpetuation of aplastic anemia (AA) pathogenesis has been found to be associated with gut inflammatory disorders (GIDs). GIDs have a powerful impact on hematopoietic and immune functions. Treatment of GIDs can improve hematological profile and immunological derangement.

Research objectives

To explore CT imaging presentations of gut inflammatory damage in adult patients with severe AA (SAA) and to provoke awareness of GIDs in the pathogenesis of hematological and autoimmune disorders.

Research methods

We retrospectively evaluated the abdominal CT imaging presentations of 17 hospitalized adult patients with SAA in search of the inflammatory niche when they presented with systemic inflammatory stress and exacerbated hematopoietic function.

Research results

All eligible patients with SAA had CT imaging abnormalities that suggested the presence of an impaired intestinal barrier and increased epithelial permeability. The inflammatory damages were concurrently present in the small intestine, the ileocecal region and the large intestines.

Research conclusions

All patients with SAA had CT imaging patterns that suggested the presence of active chronic inflammatory conditions and aggravated inflammatory damage during flared inflammatory episodes. In patients with aggravated cytopenia and clinical presentations suggestive of the presence of inflammatory responses, inflammatory diseases in the gastrointestinal tract should be considered, abdominal CT should be performed, and imaging signs that suggest the presence of gut inflammatory lesions should be carefully identified.

Research perspectives

Abdominal CT imaging presentations in association with hematopoietic failure and autoimmune diseases warrant extensive investigations.