Zarbalian Yousef, von Rosenvinge Erik C, Twadell William, Mikdashi Jamal
Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
BMJ Case Rep. 2013 Aug 23;2013:bcr2013200308. doi: 10.1136/bcr-2013-200308.
A 51-year-old woman with dermatomyositis (DM) on chronic immunosuppressive therapy was hospitalised for evaluation of haematuria. Surprisingly, abdominal imaging demonstrated pneumoperitoneum and pneumatosis intestinalis (PI). Her abdominal examination and white cell count were normal, but she subsequently developed nausea and fever. Owing to concern for perforation, a hemicolectomy was performed. Pathology revealed PI without inflammatory, ischaemic or neoplastic features, and she recovered uneventfully. Her immunosuppressive therapy was discontinued. Six months later, a follow-up CT of the abdomen revealed recurrence of PI. As she was asymptomatic, she was managed conservatively with resolution of PI on subsequent imaging. PI is characterised by the presence of gas within the wall of the intestine. Its aetiology is often unclear but this case highlights the association between PI and both immunosuppressive therapy and DM. A review of PI in patients with DM suggests that clinically stable patients may be observed, while avoiding surgical intervention.
一名51岁患有皮肌炎（DM）且正在接受慢性免疫抑制治疗的女性因血尿评估而住院。令人惊讶的是，腹部影像学检查显示有气腹和肠壁积气（PI）。她的腹部检查和白细胞计数正常，但随后出现恶心和发热。由于担心穿孔，进行了半结肠切除术。病理显示PI无炎症、缺血或肿瘤特征，她恢复顺利。她的免疫抑制治疗被停用。六个月后，腹部CT随访显示PI复发。由于她无症状，采取了保守治疗，后续影像学检查显示PI消退。PI的特征是肠壁内存在气体。其病因通常不明，但该病例突出了PI与免疫抑制治疗和DM之间的关联。对DM患者的PI进行的综述表明，对于临床稳定的患者可进行观察，同时避免手术干预。
