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CASE REPORT
Unusual cause for intestinal perforation in juvenile dermatomyositis
  1. Harikrishnan Bhaskaran and
  2. Suma Balan
  1. Department of Clinical Immunology and Rheumatology, Amrita Institute of Medical Sciences and Research Centre, Ernakulam, Kerala, India
  1. Correspondence to Dr Suma Balan, sumabalan{at}gmail.com

Abstract

We report a case of juvenile dermatomyositis (JDM) with cytomegalovirus (CMV) colitis which was further complicated with perforation. The patient, a 6-year-old girl, was diagnosed with JDM 1 month prior to the current presentation. After 2 weeks of optimising her treatment with steroid, intravenous Ig and methotrexate, she was readmitted with diffuse abdominal pain. Erect abdominal X-ray revealed gas under diaphragm. An exploratory laparotomy showed perforation of the large intestine. A biopsy showed inclusion bodies of CMV with immunohistochemistry for CMV positive. Strong positive CMV DNA PCR from tissue specimen, positive IgG CMV and negative IgM CMV in blood suggested a reactivation of CMV. The treatment followed included surgery and strategic use of antiviral agents as well as immunomodulators. CMV enteritis with complications should also be suspected in optimally treated autoimmune disease patients, including JDM, when they present with abdominal symptoms.

  • immunology
  • paediatrics
  • rheumatology
  • paediatric surgery
  • infection (gastroenterology)
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Footnotes

  • Contributors SB was the primary physician who diagnosed and subsequently followed up this patient’s outcome. HB was the resident in charge of the case and compiled the case study. Both were involved in the acute care of this patient. SB gave advice on the most relevant and applicable information from the case. HB selected appropriate images, detailing the findings shown. SB reviewed the final stages of the case report to ensure that necessary information had not been missed and that all key learning points were covered.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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