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Intestinal perforation, a rare complication of interleukin (IL)-6 therapy for immune-mediated diseases (mainly rheumatoid arthritis), typically manifests in the lower gastrointestinal tract, often in association with prior history of diverticulitis. Patients may present with acute abdominal pain and suspicion for this complication should remain high even in the absence of elevated C-reactive protein. We describe a 69-year-old female patient with a history of resistant seropositive palindromic rheumatism treated with sarilumab who developed a nontraumatic terminal ileal perforation., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2025 Sociedad Española de Reumatología (SER), Colegio Mexicano de Reumatología (CMR) and Elsevier España, S.L.U. All rights reserved.)