A Case of Drug-Induced Colitis Complicating the Administration Of

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Unusual Cases and Technical Notes 511 , 1 Clos- , 1 , 1 2 , K. Muta ,T.Yao 1 , M. Matsumoto 2 , H. Kubo 1 1 colitis associated with , K. Ito 1 , T. Ueda 1 , N. Harada , M. Takata med.kyushu-u.ac.jp 1 1 UCTN tridium difficile cancer chemotherapy. Arch Intern Med 1982; 142: 333–335 Dept. of Medicine and Bioregulatory Science Kyushu University 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan Fax:E-mail: ysada@intmed3. + 81-92-642-5287 Slavin RE, Diasarabinoside-induced MA, Saral R.toxic gastrointestinal Cytosine alterations in sequentialtherapeutic protocols. chemo- Cancer 1978; 42: 1747–1759 Milles SS, Muggia AL, Spiro HM.histologic Colonic changes induced by 5-fluoro- uracil. Gastroenterology391–399 1962; 43: Iveson TJ, Chan A.colitis Pseudomembranous complicatingLancet 1992; 339: 192–193 chemotherapy. Fukuda K, Kazami A, Ninomiya I etFU al. 5- induced colitis:Stomach Intest report 2000; 35: of 1185–1190 a case. Cucmore MA, Silva J, Fekety R et al. Corresponding Author Graduate School of Medical Sciences Y. Sadamoto, M.D. Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan School of Medical Sciences, Kyushu Dept. of Medicine and Bioregulatory Dept. of Surgical Pathology, Graduate University, Fukuoka, Japan 4 2 3 5 1 M. Kubokawa 1 H. Nawata 2 M. Tanaka References drug-induced diarrhea and intreatment reaching decision. a Y. Sadamoto chemo- a Photomicrograph of the in- Some of the crypts were dilated and Figure 2 a flamed colonic mucosa,and with regenerative degenerated toxylin-eosin, epithelial original cryptsb magnification (hema- ” 25). showed mild atypia,bodies (hematoxylin-eosin, with original manycation magnifi- ” 100) apoptotic was initiated. The diarrheanal and pain abdomi- rapidly improved. Two weekster, la- colonoscopy demonstrated a marked improvement in thenumber ulcers, and in size. termssion of Hematological was induced remis- by interferon- therapy, and the patientther has had abdominal no symptoms fur- year. for about a a rare condition [3,4],features but its have endoscopic only rarelyin been the reported literature. Inbeen addition, no previous there reports have ofinduced severe colitis by hydroxycarbamide, aspresent in case. the The endoscopicthis features case in were similarinduced to by those 5-FU, described of in colitis report a [5]. previous In theendoscopic present examination case, and bothpathological the the findings in histo- the biopsymen speci- were very useful for the diagnosis of Colitis induced by anticancer drugs is not ). In view 2 ). Histological 1 Colonoscopic view of irregularly A 62-year-old man was admitted into order receive chemotherapy fordays CML. after A hydroxycarbamide administra- few tion (2000 mg/day),oped the abdominal pain and patient severe diarrhea. devel- Infectious colitis and antibiotic-associat- ed colitis were excluded clinically. The ab- dominal painworsened, and despite treatment. diarrheascopic A examination gradually colono- carried outafter the 2weeks start of hydroxycarbamide treat- ment showed multiple irregularly demar- cated ulcers, extending from thecolon sigmoid to the cecum (Figure specimens showed inflamed colonic mu- cosa with degenerated andepithelial crypts, regenerative some of whichlated, were di- andmany revealed apoptotic bodies mild (Figure atypia, with the use of anti-cancer drugs, especiallyfluorouracil 5- (5-FU), is a common problem in the treatment of malignant2]. disease [1, Hydroxycarbamideused is antimetabolite, a whichline commonly is anticancer drug used the in the first- treatment of chronic myeloblastic leukemiaNo (CML). cases ofcolitis have hydroxycarbamide-induced so far been reported. Figure 1 demarcated ulcers in the descending colon A Case of Drug-Induced Colitis Complicating the Administration of Hydroxycarbamide stopped, and total parenteral nutrition of these characteristicendoscopic features, histological a diagnosis and ofinduced colitis by the anticancer drug was made. Gastrointestinal toxicity associated with The hydroxycarbamide treatment was

Sadamoto Y et al. A Case of Drug-Induced Colitis Complicating … Endoscopy 2002; 34: 511