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Recurrent pneumatosis intestinalis in a patient with dermatomyositis

Yousef Zarbalian1, Erik C von Rosenvinge, William Twadell

  • 1Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.

BMJ Case Reports
|August 27, 2013
PubMed

Insights

Pneumatosis intestinalis (PI), a condition with gas in the intestinal wall, can occur in dermatomyositis (DM) patients on immunosuppressants. Clinically stable patients with PI may benefit from conservative management rather than surgery.

Area of Science:

  • Gastroenterology
  • Rheumatology
  • Immunology

Background:

  • Dermatomyositis (DM) is an autoimmune disease often managed with immunosuppressive therapy.
  • Pneumatosis intestinalis (PI) is characterized by gas within the intestinal wall, with unclear etiology.
  • The association between DM, immunosuppression, and PI requires further investigation.

Observation:

  • A 51-year-old woman with DM on immunosuppressants presented with hematuria and incidentally found pneumoperitoneum and PI.
  • Despite normal initial abdominal exams and white cell count, she developed nausea and fever, leading to a hemicolectomy.
  • Pathology revealed PI without signs of inflammation, ischemia, or neoplasia, with an uneventful recovery after surgery and discontinuation of immunosuppressants.

Findings:

  • Recurrence of PI was observed six months later in the same patient, despite being asymptomatic.
  • Conservative management led to the resolution of PI on subsequent imaging.
  • This case highlights a potential association between PI and both immunosuppressive therapy and DM.

Implications:

  • The findings suggest that PI in DM patients, particularly when asymptomatic, may be managed conservatively.
  • Avoiding surgical intervention in clinically stable patients with PI associated with DM could be a viable strategy.
  • Further research is warranted to elucidate the mechanisms linking DM, immunosuppression, and PI.

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