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Kim, Kim, Kim, Kim, and Lee: Acute Hemorrhagic Colitis Induced by Oral Administration of Oseltamivir
Case Report

The Ewha Medical Journal 2016; 39(2): 56-60.

Published online: 29 April 2016

DOI: https://doi.org/10.12771/emj.2016.39.2.56

Acute Hemorrhagic Colitis Induced by Oral Administration of Oseltamivir

Hyun Soo Kim, Min Wook Kim, Si Ho Kim, Geun Kim, Jung Hyun Lee

Department of Internal Medicine, Hongik Hospital, Seoul, Korea.

Corresponding author: Jung-Hyun Lee. Department of Internal Medicine, Hongik Hospital, 250 Gukhoe-daero, Yangcheon-gu, Seoul 07937, Korea. Tel: 82-2-2600-0731, Fax: 82-2-2600-0714, drprin@naver.com

Received 7 December 2015       Accepted 11 April 2016

Copyright © 2016, The Ewha Medical Journal

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Oseltamivir has been used as a worldwide preparation for treatment of influenza A and B including H1N1. Gastrointestinal discomforts as like nausea, vomiting are commonly reported but acute hemorrhagic colitis is a very rare adverse effect. We report a case of a 17-year-old male who showed abdominal pain, diarrhea and hematochezia after the second administration of oseltamivir. Computed tomography revealed continuous, circumferential and edematous wall thickening involving ascending to descending colon with pericolic infiltration. Colonoscopic examination revealed diffuse mucosal edema, congestion and friability, suggesting hemorrhagic colitis. Histopathological examination showed ischemia and focal loss of the crypts. It also showed hyalinization and minimal inflammatory cell infiltration in the lamina propria, consistent with acute to subacute ischemic colitis. This report is the first case of oseltamivir-related ischemic colitis proved by both endoscopic examination and pathologic findings in the patient who had no risk factor of ischemic colitis in Korea.

Keywords: Oseltamivir, Hemorrhagic colitis, Influenza

Figures and Tables

Fig. 1

Abdominal computed tomography. (A) In axial view, it shows circumferential and edematous wall thickening involving ascending to descending colon (arrows). (B) In coronal view, it shows continuous transverse wall thickening and pericolic infiltration (arrow).

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Fig. 2

Colonoscopic findings at transverse colon. It shows that (A) diffuse mucosal edema, congestion and friability and (B) dramatically healed state in 5 days later follow-up.

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Fig. 3

Microscopic findings. Histologic findings show (A) relatively preserved cryptal architecture with diffuse ischemia and surface epithelial loss (H&E, ×40) and (B) ischemic change and minimal to mild infiltration of the inflammatory cells in the lamina propria (H&E, ×200).

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