1633 Extensive Colonic Ischemia Due to Sumatriptan: An Unusual Adverse Effect

Abstract

INTRODUCTION: Ischemic colitis (IC) is attributed to variety of etiologies including hypo-perforation due to dehydration, sepsis; thrombosis and embolic/thrombotic arterial occlusion. Pharmacological agents like 5Hydroxytryptamine1 (5HT 1) receptor agonists including Sumatriptan, widely used for refractory headaches, have also been known to be a cause of IC in rare circumstances. There are approximately 12 cases of IC reported which are related to 5 HT1 use. We are reporting a case of IC, which is likely related to long-term use of Sumatriptan. CASE DESCRIPTION/METHODS: A 39-year-old female with no significant past medical history was admitted to medical floor due to diffuse crampy abdominal pain and bloody diarrhea. Laboratory workup shows WBC 11500 cell/ml and negative IBD serology. CT of the abdomen and pelvis revealed pan-colitis. Stool culture and C. Difficile DNA were negative. Colonoscopy performed during admission revealed severe colitis involving entire colon except the rectum and distal sigmoid colon, biopsy featured ischemic colitis. A mesenteric Doppler ultrasound was ordered which was not conclusive, subsequently CTA performed which showed no mesenteric vascular stenosis. She was not on oral contraceptive pills and through careful questioning she mentioned that she had been taking Sumatriptan for a while. Due to the presumed association between Sumatriptan and IC, Sumatriptan was discontinued. She was emperically started on mesalamine and steroid, which were discontinued. Her symptoms improved with conservative management. A repeat colonoscopy in a few months after her hospital discharge did not show any colitis or ileitis; random colonic biopsies were unremarkable while she was off sumatriptan. DISCUSSION: Although rare, Sumatriptan use can be associated with IC, therefore we should be vigilant in reviewing medication lists in situations where there is no obvious etiology. Incidence of drug-related ischemia might be more than reported. It is imperative to counsel about meidcation adverse effect and reporting adverse effects.