Jejunal perforation complicating dermatomyositis

Donghyoun Lee; Woo Seong Jeong; Chang Lim Hyun; Jinseok Kim

doi:10.1016/j.ijscr.2019.04.010

Jejunal perforation complicating dermatomyositis

Int J Surg Case Rep. 2019:65:245-248. doi: 10.1016/j.ijscr.2019.04.010. Epub 2019 Apr 10.

Authors

Donghyoun Lee¹, Woo Seong Jeong², Chang Lim Hyun³, Jinseok Kim⁴

Affiliations

¹ Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju Self-governing Province, South Korea.
² Division of Rheumatology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju Self-governing Province, South Korea.
³ Department of Pathology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju Self-governing Province, South Korea.
⁴ Division of Rheumatology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju Self-governing Province, South Korea. Electronic address: jskim.jejunuh@gmail.com.

Abstract

Introduction: Small bowel perforation is rare in dermatomyositis (DM). However, it is associated with high rates of morbidity and mortality. In line with the SCARE criteria, we describe a case of jejunal perforation for a DM patient (Agha et al., 2018 [1]).

Case presentation: A 63-year-old woman had been treated for DM with high dose steroid 1 month prior to the onset of severe abdominal pain. Computed tomography (CT) revealed free air in abdominal cavity and fluid around the small bowel. She was diagnosed with small bowel perforation and underwent emergency surgery. Emergent surgery showed perforated jejunum which was resected. Pathologic reports revealed mesenteric small-vessel vasculitis with a perivascular inflammatory cell infiltration.

Conclusion: Perforation of the small bowel for DM patients is rare. However, the early diagnosis of bowel perforation is difficult in DM because it can mimic other gastrointestinal manifestations such as ileus, ischemic colitis and peritonitis. To minimize mortality via an early diagnosis and a timely treatment, it is important to examine the patient's clinical history and employ a proper medical imaging modality such as CT even when lab findings are nonspecific and atypical.

Keywords: Dermatomyositis; Intestinal; Perforation; Small bowel.