Ewha Med J.  2016 Apr;39(2):56-60. 10.12771/emj.2016.39.2.56.

Acute Hemorrhagic Colitis Induced by Oral Administration of Oseltamivir

• Kim HS
• Kim MW
• Kim SH
• Kim G
• Lee JH

• KMID: 2171366
• DOI: http://doi.org/10.12771/emj.2016.39.2.56

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.

Keyword

Oseltamivir; Hemorrhagic colitis; Influenza

MeSH Terms

Abdominal Pain
Administration, Oral*
Adolescent
Colitis*
Colitis, Ischemic
Colon, Descending
Diarrhea
Edema
Estrogens, Conjugated (USP)
Gastrointestinal Hemorrhage
Humans
Hyalin
Influenza, Human
Ischemia
Korea
Male
Mucous Membrane
Nausea
Oseltamivir*
Risk Factors
Vomiting
Estrogens, Conjugated (USP)
Oseltamivir

Figure

• 

  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).

• 

  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.

• 

  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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