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Crystal-Associated Colitis with Ulceration Leading to Hematochezia and Abdominal Pain
Meeta Desai1, Aaron Reiprich2, Nancy Khov3
1Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pa., USA.
Insights
Medication-associated mucosal injury from ion-exchange resins like sevelamer can cause lower GI bleeding. Discontinuing these drugs resolved a patient's rectal bleeding and abdominal pain, highlighting an underrecognized cause of hematochezia.
Area of Science:
- Gastroenterology
- Nephrology
- Oncology
Background:
- Lower gastrointestinal (GI) bleeding is a frequent reason for adult hospitalization.
- Medication-associated mucosal injury is a significant clinical issue linked to morbidity and mortality.
Observation:
- A 45-year-old woman presented with a 3-month history of abdominal cramping and rectal bleeding.
- Her medical history included end-stage renal disease and prior radiation therapy for endometrial carcinoma.
- Initial evaluations suggested ischemic or radiation colitis, but histology revealed acute inflammation and ulceration with crystal fragments.
Findings:
- Histological findings were consistent with acute inflammation and ulceration attributed to crystal fragments.
- Sevelamer and cholestyramine, common ion-exchange resins, were identified as potential causes of mucosal damage.
- Discontinuation of these medications led to the resolution of the patient's symptoms.
Implications:
- This case underscores the importance of considering medication-induced mucosal injury in patients with lower GI bleeding.
- Ion-exchange resins should be evaluated as a potential etiology for unexplained hematochezia.
- Recognizing this underappreciated cause can prevent misdiagnosis and improve patient outcomes.
Abstract:
Lower GI bleeding is a common cause for hospitalization in adults. Medication-associated mucosal injury is an important clinical entity that can result in significant morbidity and mortality. We present the case of a 45-year-old woman with a 3-month history of intermittent abdominal cramping and rectal bleeding. Her medical history was extensive and included end-stage renal disease and a remote history of endometrial carcinoma that was treated with radiation. Initial workup was concerning for ischemic and radiation colitis, however, histology was most consistent with acute inflammation and ulceration associated with crystal fragments. Sevelamer and cholestyramine are commonly used ion-exchange resins that have been associated with mucosal damage. Both medications were discontinued and her symptoms resolved. Our case highlights an underrecognized but important cause of hematochezia.
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