Anti-glutamic acid decarboxylase autoimmunity presenting as chronic intestinal pseudo-obstruction with dysautonomia and late-onset autoimmune diabetes: A case report

Figure 1 Abdominal radiography and computed tomography findings. A: Abdominal radiograph showing a bowel gas pattern within normal limits, with evidence of fecal loading; B: Contrast-enhanced computed tomography of the abdomen and pelvis demonstrating mild dilatation of the jejunum with fluid-filled loops and associated fecalization of the ileum. The distal ileum and ileocaecal valve are of normal caliber. The large bowel is relatively decompressed, with no intra-abdominal free fluid or air.

Figure 2 Computed tomography demonstrating small-bowel dilatation. Contrast-enhanced computed tomography showing multiple distended small-bowel loops measuring up to 4.3 cm in diameter, with a transition point in the right hemipelvis. The large bowel is of normal caliber, with fecal loading in the caecum and evidence of small-bowel fecalization.

Figure 3 Magnetic resonance imaging of the small bowel. Magnetic resonance image demonstrating feces throughout the colon and fluid-filled small-bowel loops distributed throughout the abdomen. No focal small-bowel abnormality is identified.

Figure 4 Treatment timeline. Timeline illustrating the clinical course and therapeutic interventions, including initial presentation with obstructive symptoms, partial response to prokinetic therapy, marked improvement following corticosteroids and intravenous immunoglobulins, subsequent relapse, and sustained remission after treatment with intravenous methylprednisolone, intravenous immunoglobulins, and rituximab. IVIG: Intravenous immunoglobulins; IVMP: Intravenous methylprednisolone.