Lesson of the month
Intestinal perforation in a patient with severe ankylosing spondylitis
Department of Rheumatology, South Cleveland
Hospital, Middlesbrough, Cleveland
Correspondence to: Dr J N Fordham, Department of Rheumatology, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW.
Accepted for publication 20 May 1997
| The first 150 words of the full text of this article appear below. |
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Case history |
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A 54 year old man who had suffered from predominantly axial ankylosing spondylitis for 25 years was referred to see a gastroenterologist because of pallor in 1983. He was found to be anaemic, haemoglobin (Hb) 7.7 g/dl (13-18), mean cell volume (MCV) 57 fl (78-98), mean corpuscular haemoglobin (MCV) 17.5 pg (27.5-32.5), ferritin 27 µg/l (41-480), B12 and folate within normal limits, and to have a raised plasma viscosity 2.17 cps (1.5-1.72). He was taking indomethacin 25 mg thrice daily. Upper gastrointestinal endoscopy and barium enema were normal. The small bowel was not visualised and despite a microcytic hypochromic picture an anaemia of chronic disease was diagnosed. The haemoglobin had subsequently returned towards normal limits, Hb 10.3 g/dl, MCV 66 fl, MCH 20.3 pg, and ferritin 58 µg/l, when reviewed one year later.
At the age of 60 years the patient attended the rheumatology department
for the first time. Severe, predominantly axial, ankylosing spondylitis
was noted with no lumbar spine movement and only
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