de Silva et al. Journal of Medical Case Reports 2010, 4:299 http://www.jmedicalcasereports.com/content/4/1/299 Page 3 of 3 Figure 3 Retroperioneal abscess secondary to perforated sigmoid tumor. for a residual retroperitoneal abscess (Figure 3). Tazocin and gentamicin were administered as antibiotics. Histo- pathology confirmed a T4 N2 Mx moderately differen- tiated adenocarcinoma with incomplete resection margins. After a protracted stay in intensive care with multi-organ failure, she was discharged home and received palliative chemotherapy. Conclusions Patients with polymyalgia may have perforated colonic or purulent diverticular disease which mimics their rheumatic pathology. In such cases steroid therapy which is the mainstay of polymyalgia therapy can be detrimental [5]. Although in both cases our patients’ main complaint was joint/musculoskeletal pain, they also had non-specific gastrointestinal symptoms at a preceding early stage. In the presence of atypical symp- toms that cannot be attributed to polymyalgia, such as diarrhea, abdominal pain or weight loss, a high degree of clinical suspicion should be maintained for an alter- native primary gastrointestinal pathology. These two cases highlight the importance of paying close attention to abdominal symptoms that cannot be attributed to polymyalgia and the need to exclude a pri- mary intra-abdominal pathology first. Abdominal X- rays, ultrasound and sigmoidoscopy may be misleading and therefore if patients fail to improve, prompt imaging with CT/MRI is recommended in order to initiate appropriate therapy before patients become too unstable to receive treatment [6,7]. Case 1 highlights how plain film imaging may fail to detect perforations due to the absence of significant pneumoperitoneum. Abbreviations BMI: body mass index; CRP: C-reactive protein; CT: computed tomography; MRI: magnetic resonance imaging; PMR: polymyalgia rheumatica. Consent Written informed consent was obtained from the relatives of the patient in Case 1 for publication of this case report and accompanying images. A copy of the written consent is available for review by the journal’s Editor-in-Chief. Written informed consent could not be obtained from patient 2 because the patient is now deceased and we were unable to contact a next of kin despite reasonable attempts. Every effort has been made to protect the identity of the patient and there is no reason to believe that the family would object to publication. Conflict of interest The authors declare that there is no conflict of interest. No funding was sought or received for this report. Competing interests The authors declare that they have no competing interests. Authors’ contributions PdeS was involved in the management of Case 1, and was involved in conception of the case reports, data acquisition, literature review, writing the article and critical revision. GV was involved in management of the cases, conception and critical revision. NP was involved in the management of Case 2, data acquisition and critical revision. All authors read and approved the final manuscript. Author details 1Department of Gastroenterology, James Paget University Hospital, Lowestoft Road, Great Yarmouth, NR31 6LA, UK. 2Department of Surgery, James Paget University Hospital, Lowestoft Road, Great Yarmouth, NR31 6LA, UK. 3Department of Gastroenterology, James Paget University Hospital, Lowestoft Road, Great Yarmouth NR31 6LA, UK. Received: 22 September 2009 Accepted: 6 September 2010 Published: 6 September 2010 References 1. Cimmino MA, Zaccaria A: Epidemiology of polymyalgia rheumatica. Clin Exp Rheumatol 2000, 18(4 Suppl 20):S9-11. 2. Michet CJ, Matteson EL: Polymyalgia rheumatica. BMJ 2008, 336(7647):765-769. 3. Dasgupta B, Kalke S: Polymalgia rheumatica. In Oxford textbook of rheumatology. Edited by: Isenberg D, Maddison P, Woo P, Glass D, Breedveld FC. Oxford: Oxford University Press; , 32004:977-983. 4. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Olivieri I, Hunder GG: The spectrum of conditions mimicking polymyalgia rheumatica in northwestern Spain. J Rheumatol 2000, 27:2179-2184. 5. Mpofu S, Mpofu CMA, Hutchinson D, et al: Steroids, non-steroidal anti- inflammatory drugs, and sigmoid diverticular abscess perforation in rheumatic conditions. Annals of the Rheumatic Diseases 2004, 63:588-590. 6. Sarma D, Longo WE: Diagnostic Imaging for Diverticulitis. J Clin Gastroenterol 2008, 42(10):1139-1141. 7. Halligan S, Saunders B: Imaging diverticular disease. Best Pract Res Clin Gastroenterol 2002, 16:595-610. doi:10.1186/1752-1947-4-299 Cite this article as: de Silva et al.: Presentations of perforated colonic pathology in patients with polymyalgia rheumatica: two case reports. Journal of Medical Case Reports 2010 4:299.