Pneumatosis intestinalis: Cost paid for rheumatoid arthritis treatment

Department

Internal Medicine

Document Type

Article

Publication Title

BMJ Case Reports

Abstract

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.

DOI

10.1136/bcr-2019-229329

Volume

12

Issue

7

Publication Date

1-1-2019

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