RT Journal Article SR Electronic T1 Pneumatosis intestinalis: cost paid for rheumatoid arthritis treatment JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e229329 DO 10.1136/bcr-2019-229329 VO 12 IS 7 A1 Pratyusha Tirumanisetty A1 Jose William Sotelo A1 Michael Disalle A1 Meenal Sharma YR 2019 UL http://casereports.bmj.com/content/12/7/e229329.abstract AB 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.