Dermatomyositis Associated with Bilateral Ureteral Spontaneous Rupture

Dermatomyositis associated with genitourinary malignancies is not uncommon. However, only a few cases associated with ureteral stricture have been reported, and ureteral rupture is even rarer. A 56-year-old woman with dermatomyositis who had been treated with prednisolone, cyclophosphamide, and azathioprine for 2 months presented with fever, hematuria, and abdominal pain for 2 days. Radiographic imaging revealed bilateral ureteral spontaneous rupture and intraperitoneal urinoma formation. Urine cytology and endourologic examinations showed no evidence of genitourinary malignancy. Ureteral urine leakage was managed successfully by drainage through percutaneous catheter and bilateral double-J ureteral stenting. The stents were removed 9 months later. Follow-up intravenous urography 12 months after ureteral stent placement showed good renal function with left mild hydronephrosis and hydroureter above the previous rupture site. Bilateral ureters were patent and there was no evidence of contrast medium extravasation from either ureter. Diuretic renal scanning also showed bilateral nonmechanical obstruction with left-side mild hydronephrosis without urine extravasation. Dermatomyositis can be complicated with spontaneous ureteral rupture. Conservative management with urinary diversion and stenting is feasible. [J Formos Med Assoc 2007;106(3):251-254