Diverticular Perforation with Normal C-reactive Protein in a Patient with Neuromyelitis Optica Spectrum Disorder Receiving Satralizumab
Abstract
Interleukin-6 blockade can blunt inflammatory biomarkers and mask serious infection. A 49-year-old woman with neuromyelitis optica spectrum disorder receiving satralizumab presented with mild abdominal pain; C-reactive protein levels were normal at the time of perforation despite a transient elevation early during hospitalization. Computed tomography revealed colonic diverticular perforation with a localized abscess. She improved with percutaneous drainage, targeted antimicrobials, and withdrawal of satralizumab, followed by transition to ravulizumab. This case suggests that satralizumab may obscure inflammatory responses, delaying recognition of gastrointestinal perforation. Normal C-reactive protein levels do not exclude complicated diverticulitis during interleukin-6 receptor blockade; early imaging and a low threshold for intervention are essential.
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BibTeX
@article{kitazawa2026diverticular,
title = {{Diverticular Perforation with Normal C-reactive Protein in a Patient with Neuromyelitis Optica Spectrum Disorder Receiving Satralizumab}},
author = {Miharu Kitazawa and Naoto Osugi and Eri Hayano and Kengo Matsumoto and Masashi Yamamoto and Masaru Yokoe and Tsutomu Nishida},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.6726-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/18/65_6726-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Diverticular Perforation with Normal C-reactive Protein in a Patient with Neuromyelitis Optica Spectrum Disorder Receiving Satralizumab
AU - Miharu Kitazawa
AU - Naoto Osugi
AU - Eri Hayano
AU - Kengo Matsumoto
AU - Masashi Yamamoto
AU - Masaru Yokoe
AU - Tsutomu Nishida
PY - 2026
DA - 2026/09/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.6726-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/18/65_6726-25/_article
AB - Interleukin-6 blockade can blunt inflammatory biomarkers and mask serious infection. A 49-year-old woman with neuromyelitis optica spectrum disorder receiving satralizumab presented with mild abdominal pain; C-reactive protein levels were normal at the time of perforation despite a transient elevation early during hospitalization. Computed tomography revealed colonic diverticular perforation with a localized abscess. She improved with percutaneous drainage, targeted antimicrobials, and withdrawal of satralizumab, followed by transition to ravulizumab. This case suggests that satralizumab may obscure inflammatory responses, delaying recognition of gastrointestinal perforation. Normal C-reactive protein levels do not exclude complicated diverticulitis during interleukin-6 receptor blockade; early imaging and a low threshold for intervention are essential.
SN - 1349-7235
SN - 0918-2918
ER -