tailieunhanh - báo cáo khoa học: "Presentations of perforated colonic pathology in patients with polymyalgia rheumatica: two case reports"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Presentations of perforated colonic pathology in patients with polymyalgia rheumatica: two case reports | de Silva et al. Journal of Medical Case Reports 2010 4 299 http content 4 1 299 jAg JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Presentations of perforated colonic pathology in patients with polymyalgia rheumatica two case reports Punyanganie de Silva1 Nagarajan Pranesh2 Guy Vautier3 Abstract Introduction Polymyalgia rheumatica is an increasingly common disease in older people which gives rise to arthralgia and is mainly treated with corticosteroids. Patients in this age group also have a higher incidence of other co-morbidities including colonic pathology. Corticosteroid usage may mask signs of sepsis or complications secondary to intra-abdominal pathology thereby delaying diagnosis and treatment with eventual adverse outcome. These two cases highlight the importance of awareness and prompt recognition of this condition in order to avoid significant morbidity and mortality. Case presentation Case 1 A 73-year-old Caucasian woman with a diagnosis of polymyalgia presented with symptoms of an exacerbation in her right hip joint. Despite standard therapy with corticosteroids she failed to improve and started to develop features of widespread sepsis. Specific questioning revealed that at the very onset of her symptoms she had experienced mild diarrheal symptoms. Investigations revealed perforated diverticular disease with a perifemoral abscess. Case 2 A 69-year-old Caucasian woman with polymyalgia presented with left thigh pain and weakness associated with weight loss. A diagnosis of exacerbation of polymyalgia rheumatica was made and she was treated with corticosteroid therapy. Shortly afterwards she was admitted with generalized peritonitis. Laparotomy revealed a retroperitoneal abscess secondary to a perforated sigmoid colonic tumor. Conclusions Patients with polymyalgia may have perforated colonic diverticular disease which mimics their rheumatic pathology. In such cases steroid therapy which is the mainstay of polymyalgia