title: Juvenile dermatomyositis complicated with vasculitis and duodenal perforation.
abstract: Duodenal perforation has been reported in patients taking steroids and non-steroidal anti-inflammatory drugs (NSAIDs). However, its association with juvenile dermatomyositis is extremely rare. A 4-year-old boy with dermatomyositis presented with intractable abdominal pain which was aggravated after steroid and NSAID therapies. A widespread retroperitoneal abscess was noted on abdominal computerized tomography. An emergency operation showed an ulcer and perforation at the junction of the third and fourth portions of the duodenum. Debridement of the necrotic tissue and repair of the perforation were performed. The postoperative course was complicated by an anastomotic leak, which was corrected by reanastomosis. In addition to intestinal vasculitis, duodenal vasculitis complicated with ulcers and perforation should be included in the differential diagnosis of a child with juvenile dermatomyositis presenting with abdominal complaints.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
authors.forename: I J
authors.initials: IJ
authors.lastname: Wang
authors.forename: W M
authors.initials: WM
authors.lastname: Hsu
authors.forename: C T
authors.initials: CT
authors.lastname: Shun
authors.forename: B L
authors.initials: BL
authors.lastname: Chiang
authors.forename: Y H
authors.initials: YH
authors.lastname: Ni
mesh_terms: D018784:Abdominal Abscess / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D003882:Dermatomyositis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004378:Duodenal Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004386:Duodenum / Q000098:blood supply; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012187:Retroperitoneal Space; D014657:Vasculitis / Q000150:complications* / Q000175:diagnosis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D011239:Prednisolone