Diverticular Perforation with Normal C-reactive Protein in a Patient with Neuromyelitis Optica Spectrum Disorder Receiving Satralizumab.
Miharu Kitazawa, Naoto Osugi, Eri Hayano et al.
✦ AI-curated · Sources linked
Case in brief
A 49-year-old woman with neuromyelitis optica spectrum disorder receiving satralizumab developed mild abdominal pain. Although C-reactive protein had risen transiently earlier in her hospitalization, it was normal when computed tomography showed colonic diverticular perforation with a localized abscess. She improved after percutaneous drainage and targeted antimicrobial therapy. Satralizumab was withdrawn, and she was transitioned to ravulizumab.
What made this case unusual
The perforation and localized abscess were present despite a normal C-reactive protein level during interleukin-6 receptor blockade, potentially obscuring the severity of the abdominal process.
Diagnostic / clinical pearl
In patients receiving interleukin-6 receptor blockade, a normal C-reactive protein level does not exclude complicated diverticulitis; abdominal symptoms may warrant early imaging.