Open AccessPneumatosis intestinalis: cost paid for rheumatoid arthritis treatment
Author(s) -
Pratyusha Tirumanisetty,
Jose William Sotelo,
Michael DiSalle,
Meenal Sharma
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-229329
Subject(s) - medicine , pneumatosis intestinalis , exploratory laparotomy , rheumatoid arthritis , perforation , rituximab , surgery , laparotomy , ileostomy , pneumatosis cystoides intestinalis , lymphoma , punching , materials science , metallurgy
A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.