TY - JOUR T1 - Pneumatosis intestinalis: cost paid for rheumatoid arthritis treatment JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-229329 VL - 12 IS - 7 SP - e229329 AU - Pratyusha Tirumanisetty AU - Jose William Sotelo AU - Michael Disalle AU - Meenal Sharma Y1 - 2019/07/01 UR - http://casereports.bmj.com/content/12/7/e229329.abstract N2 - 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. ER -