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24 May 2019 : Case report  Lebanon

Recurrent Asymptomatic Sigmoid Diverticular Perforation in a Patient with Pemphigus Vulgaris on Immunosuppressive Therapy: A Case Report

Challenging differential diagnosis, Unusual setting of medical care, Rare coexistence of disease or pathology

Christian Saliba1ABCE, Hussein Rabah2ABCE, Gregory Nicolas1ABDE*, Nancy Emmanuel3CDE, Ahmad Sleiman4CDG, Mohammad Hashem1BCDG, Rola Hussein5CDG, Ali El Masri1CDG, Rim Abboud1CDG, Mohammad Fawaz1CDG, Houssein Haidar Ahmad1ACDF

DOI: 10.12659/AJCR.913485

Am J Case Rep 2019; 20:735-738

Abstract

BACKGROUND: Perforation of the colon is associated with high mortality and requires early diagnosis. However, the diagnosis of perforation from atypical causes can be a diagnostic challenge. This report is of a rare case of recurrent sigmoid colonic perforation in a patient with diverticular disease who did not present with an acute abdomen but who had pemphigus vulgaris treated with immunosuppressive therapy.

CASE REPORT: A 57-year-old man with pemphigus vulgaris was treated with steroids, non-steroidal anti-inflammatory drugs (NSAIDS), and azathioprine. He had episodes of abdominal bloating but denied any other symptoms. He was diagnosed with spontaneous sigmoid diverticular perforation without presenting with an acute abdomen.

CONCLUSIONS: Diverticular perforation can be asymptomatic in patients on immunosuppressive therapy. Therefore, there should be a high index of suspicion for bowel perforation in patients with abdominal symptoms who are treated for skin diseases, such as pemphigus vulgaris, and are on steroids and other immunosuppressive treatments.

Keywords: diverticulitis, Intestinal Perforation, pemphigus, Anti-Inflammatory Agents, Non-Steroidal, azathioprine, Diverticulum, Colon, Immunosuppressive Agents, Middle Aged, Recurrence, Sigmoid Diseases

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923