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Ischemic Ulcerative Colitis in Juvenile Dermatomyositis

Meneghel, Alessandra MD*; Zulian, Francesco MD; Martini, Giorgia MD; Guariso, Graziella MD*

Journal of Pediatric Gastroenterology & Nutrition: November 2009 - Volume 49 - Issue 5 - p 549
doi: 10.1097/MPG.0b013e3181b83618
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*Department of Pediatrics, Gastroenterology-Endoscopy, Italy

Rheumatology Units, University of Padua, Padua, Italy

Received 11 November, 2008

Accepted 17 July, 2009

Address correspondence and reprint requests to Prof. Graziella Guariso, Dipartimento di Pediatria, Via Giustiniani 3, 35128 Padua, Italy (e-mail:

The authors report no conflicts of interest.

A 6-year-old girl with juvenile dermatomyositis (JDM), diagnosed according to the Bohan and Peter criteria (1), presented with skin ulcerations (Fig. 1) and livedo reticularis (Fig. 2). Three months after diagnosis she developed severe iron-deficiency anemia, abdominal pain, evidence of occult blood in the stool, and occasional hematochezia. Colonoscopy showed a serpiginous vascular pattern and 2 ulcers (Figs. 3 and 4). Histological findings on mucosal biopsies showed granulation tissue and mixed inflammatory infiltrate, mostly composed of granulocytes and scattered lymphocytes, with peripheral mucosal hyperplastic-reactive changes (Fig. 5).

Among the possible complications of JDM (2–9), gastrointestinal (GI) involvement is rare (3) and ulcers are more typical of the juvenile- than of the adult-onset form (2). GI vasculopathy can manifest as ulceration, haemorrhage, pneumatosis intestinalis, or perforation (4,10). These symptoms and signs may arise early in the course of the disease as a result of a noninflammatory endarteropathy or late because of chronic vasculopathy (2,10).

Vasculitides involving the GI tract are part of a systemic process, although the signs and symptoms may initially be vague (9). GI involvement should be considered in every patient with JDM associated with skin ulcerations and abdominal symptoms, to ensure appropriate immunosuppressive treatment and avoid severe complications.

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© 2009 Lippincott Williams & Wilkins, Inc.