[Ischemic colitis without atherosclerosis?]

A 69-year-old woman, who was being treated for a bipolar affective psychosis, was admitted because of abdominal pain, emesis and bloody stool.

Blood tests showed increased inflammation parameters. Ultrasound revealed a swollen intestinal wall. Coloscopy correlated with the ultrasound findings and demonstrated an ischemic colitis. The histological report at first corroborated this as the possible diagnosis. But angiography of the mesenteric vessels and duplex ultrasound of the cervical vessels were normal. COURSE AND THERAPY: The symptoms persisted under therapy with acetylsalicylic acid (100 mg daily), no food intake and intravenous fluids. The coloscopic picture and the laboratory tests remained unchanged. The findings did not normalize until most of the antipsychotic drugs, especially perazine, were discontinued. The angiographic and duplexultrasound results spoke against the initially suspected diagnosis of an ischemic origin, but for necrotizing colitis as an adverse effect of perazine. A second biopsy confirmed this explanation.

A necrotizing colitis as an adverse effect of drugs can simulate an ischemic colitis on endoscopy and in a biopsy. Even if the clinical pattern is present possible adverse reaction to the medication should be considered. The diagnosis of a necrotizing colitis was postulated only after the course of the disease had been taken into account and, in particular, atherosclerosis had been excluded as a possible cause, and an adverse reaction to the medication had been considered.