An Interesting Case of Acute Colitis Possibly Associated with Deposition of Pharmaceutical Fillers

Abstract

Abstract Introduction/Objective Crospovidone and microcrystalline cellulose, known as pharmaceutical fillers, are nonabsorbable and insoluble white powders. They are widely used in the pharmaceutical and food industries to facilitate the delivery of consumed substances and can be identified in pathological specimens from the gastrointestinal tract. Here, we report a case of diarrhea and colonic inflammation associated with extensive deposition of crospovidone and microcrystalline cellulose within the colonic mucosa. Methods/Case Report A 49-year-old male with no significant past medical history presented with abdominal pain and diarrhea for 3 weeks. CT abdomen showed wall thickening and inflammatory stranding throughout the colon, and area with possible pneumatosis coli versus pseudo-pneumatosis. Colonoscopy revealed segmental involvement with congested, erythematous and friable mucosa confined to hepatic flexure, transverse colon and splenic flexure. The biopsies of these areas showed colonic mucosa with chronic and acute inflammation, architectural distortion of the glands, melanosis coli, and extensive deposition of foreign body material within the mucosa. Closer microscopic examination of the foreign body material revealed an aggregate of coral-shaped particles with a pink center and purple periphery, which were non-birefringent under polarized light, consistent with crospovidone. Also, there was an extensive deposition of aggregates of polygonal, transparent fragments which appeared brightly birefringent under polarized light, consistent with microcrystalline cellulose. The patient denied the usage of laxatives. Results (if a Case Study enter NA) NA. Conclusion Although the data does not suggest an association between the presence of pharmaceutical fillers within the gastrointestinal tract and mucosal injury, our case suggests the possibility of associated colitis. Here, extensive mucosal deposition of crospovidone and microcrystalline cellulose shows possible association with endoscopic findings of congested and inflamed colonic mucosa, supported by microscopic examination of the sampled tissue. Hence, more investigation of iatrogenic foreign body materials, such as pharmaceutical fillers is required for optimal patient care.