Tin Swann, Lim William, Umyarova Rushaniya, Arulthasan Marutha, Daoud Magda
Internal Medicine, Richmond University Medical Center, Staten Island, USA.
Internal Medicine/Gastroenterology, Richmond University Medical Center, Staten Island, USA.
Cureus. 2021 Aug 12;13(8):e17125. doi: 10.7759/cureus.17125. eCollection 2021 Aug.
Ischemic colitis refers to an inflammatory condition of the large bowel caused by ischemia. It usually presents with an acute onset abdominal pain followed by hematochezia. It can occur as a result of arterial occlusion (embolic or thrombotic), venous thrombosis, or hypoperfusion of mesenteric circulation secondary to dehydration, surgery, or medications. Herein, we present an unusual case of sumatriptan-induced ischemic colitis. Sumatriptan succinate is a selective serotonin (5-hydroxytryptamine-1) receptor agonist that is usually prescribed for refractory migraine headaches. This is a 59-year-old female who presented with acute onset abdominal pain followed by bloody diarrhea after vigorous physical activities. She has a past medical history of non-specific colitis (one time, 15 years ago) and chronic migraine for which she was on low-dose sumatriptan therapy (one tab once or twice a week). On the day of the event, the patient took sumatriptan in the morning and had strenuous activities throughout the day, and overnight she developed abdominal pain. It was followed by bouts of bloody diarrhea. The colonoscopy revealed erythematous mucosa with significant ulceration and necrosis involving the distal transverse colon, splenic flexure, descending colon, and proximal colon, suggestive of ischemic colitis. Unlike previously reported cases, this patient was only on low-dose sumatriptan therapy without frequent dosing. So, her risk of ischemic colitis from triptan therapy could have been accelerated by excessive sweating and strenuous physical activities. The patient was treated with intravenous hydration, bowel rest, intravenous antibiotics, and withdrawal of sumatriptan and her condition improved within the next two to three days.
缺血性结肠炎是指由缺血引起的大肠炎症性疾病。通常表现为急性腹痛，随后出现便血。其可由动脉闭塞（栓塞性或血栓性）、静脉血栓形成，或继发于脱水、手术或药物的肠系膜循环灌注不足所致。在此，我们报告一例罕见的舒马曲坦诱发的缺血性结肠炎病例。琥珀酸舒马曲坦是一种选择性5-羟色胺（5-羟色胺-1）受体激动剂，通常用于治疗难治性偏头痛。这是一名59岁女性，在剧烈体育活动后出现急性腹痛，随后出现血性腹泻。她既往有非特异性结肠炎病史（15年前有过一次）和慢性偏头痛，为此她正在接受低剂量舒马曲坦治疗（每周服用1片，一次或两次）。在发病当天，患者早晨服用了舒马曲坦，全天进行了剧烈活动，当晚出现腹痛，随后出现多次血性腹泻。结肠镜检查显示黏膜红斑，伴有明显溃疡和坏死，累及横结肠远端、脾曲、降结肠和近端结肠，提示缺血性结肠炎。与先前报道的病例不同，该患者仅接受低剂量舒马曲坦治疗，且用药不频繁。因此，出汗过多和剧烈体育活动可能加速了她因曲坦类药物治疗而发生缺血性结肠炎的风险。患者接受了静脉补液、肠道休息、静脉使用抗生素治疗，并停用了舒马曲坦，其病情在接下来的两到三天内有所改善。
