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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 co-existance of disease or pathology

Christian Saliba, Hussein Rabah, Gregory Nicolas, Nancy Emmanuel, Ahmad Sleiman, Mohammad Hashem, Rola Hussein, Ali El Masri, Rim Abboud, Mohammad Fawaz, Houssein Haidar Ahmad

Division of Surgery, Saint George Hospital University Medical Center, Hadath, Lebanon

Am J Case Rep 2019; 20:735-738

DOI: 10.12659/AJCR.913485

Available online:

Published: 2019-05-24

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