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A Case of Drug-Induced Colitis Complicating the Administration Of A Case of Drug-Induced Colitis Complicating the Administration of Hydroxycarbamide UCTN Gastrointestinal toxicity associated with was initiated. The diarrhea and abdomi- drug-induced diarrhea and in reaching a the use of anti-cancer drugs, especially 5- nal pain rapidly improved. Two weeks la- treatment decision. fluorouracil (5-FU), is a common problem ter, colonoscopy demonstrated a marked in the treatment of malignant disease [1, improvement in the ulcers, in terms of Y. Sadamoto 1, T. Ueda 1, M. Matsumoto 1, 2]. Hydroxycarbamide is a commonly number and size. Hematological remis- M. Kubokawa 1, K. Ito 1, H. Kubo 1, used antimetabolite, which is the first- sion was induced by interferon-a chemo- M. Tanaka 1, N. Harada 1, K. Muta 1, Unusual Cases and Technical Notes line anticancer drug used in the treatment therapy, and the patient has had no fur- H. Nawata 1, M. Takata 2,T.Yao2 of chronic myeloblastic leukemia (CML). ther abdominal symptoms for about a 1 Dept. of Medicine and Bioregulatory No cases of hydroxycarbamide-induced year. Science, Graduate School of Medical colitis have so far been reported. Sciences, Kyushu University, Fukuoka, Colitis induced by anticancer drugs is not Japan A 62-year-old man was admitted in order a rare condition [3,4], but its endoscopic 2 Dept. of Surgical Pathology, Graduate to receive chemotherapy for CML. A few features have only rarely been reported School of Medical Sciences, Kyushu days after hydroxycarbamide administra- in the literature. In addition, there have University, Fukuoka, Japan tion (2000 mg/day), the patient devel- been no previous reports of severe colitis oped abdominal pain and severe diarrhea. induced by hydroxycarbamide, as in the References Infectious colitis and antibiotic-associat- present case. The endoscopic features in ed colitis were excluded clinically. The ab- this case were similar to those of colitis 1 Slavin RE, Dias MA, Saral R. Cytosine dominal pain and diarrhea gradually induced by 5-FU, described in a previous arabinoside-induced gastrointestinal worsened, despite treatment. A colono- report [5]. In the present case, both the toxic alterations in sequential chemo- scopic examination carried out 2weeks endoscopic examination and the histo- therapeutic protocols. Cancer 1978; 42: after the start of hydroxycarbamide treat- pathological findings in the biopsy speci- 1747–1759 ment showed multiple irregularly demar- men were very useful for the diagnosis of 2 Milles SS, Muggia AL, Spiro HM. Colonic cated ulcers, extending from the sigmoid histologic changes induced by 5-fluoro- colon to the cecum (Figure 1). Histological uracil. Gastroenterology 1962; 43: 511 specimens showed inflamed colonic mu- 391–399 cosa with degenerated and regenerative 3 Cucmore MA, Silva J, Fekety R et al. Clos- epithelial crypts, some of which were di- tridium difficile colitis associated with Sadamoto Y et al. A Case of Drug-Induced Colitis Complicatinglated, … Endoscopy 2002; 34: 511 and revealed mild atypia, with cancer chemotherapy. Arch Intern Med many apoptotic bodies (Figure 2). In view 1982; 142: 333–335 of these characteristic histological and 4 Iveson TJ, Chan A. Pseudomembranous endoscopic features, a diagnosis of colitis colitis complicating chemotherapy. induced by the anticancer drug was made. Lancet 1992; 339: 192–193 The hydroxycarbamide treatment was 5 Fukuda K, Kazami A, Ninomiya I et al. 5- stopped, and total parenteral nutrition FU induced colitis: report of a case. Stomach Intest 2000; 35: 1185–1190 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Corresponding Author Y. Sadamoto, M.D. Dept. of Medicine and Bioregulatory Science Graduate School of Medical Sciences Kyushu University 3-1-1 Maidashi, Higashi-ku Figure 2 a Photomicrograph of the in- Fukuoka 812-8582 flamed colonic mucosa, with degenerated and regenerative epithelial crypts (hema- Japan toxylin-eosin, original magnification 25). Fax: + 81-92-642-5287 b Some of the crypts were dilated and E-mail: ysada@intmed3. showed mild atypia, with many apoptotic med.kyushu-u.ac.jp Figure 1 Colonoscopic view of irregularly bodies (hematoxylin-eosin, original magnifi- demarcated ulcers in the descending colon cation 100).
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