Ischemic Pancolitis Associated with Paclitaxel (Taxol®) in a Patient with Metastatic Lung Cancer

Abstract

Purpose: Pseudomembranous colitis is the most common colonic complication of chemotherapeutic agents, however, ischemic colitis is rarely reported. Paclitaxel, a microtubule-stabilizing antineoplastic drug, is a commomly used chemotherapeutic agent. Here we report a case of metastaic lung cancer that developed severe ischemic colitis due to paclitexal. Methods: A Case Report. Results: A 71-year-old Caucasian female with adenocarcinoma of lung with multiple metastases to brain was given two courses of chemotherapy with paclitaxel (Taxol®), carboplatin and dexamethasone. One week following the 2nd course, the patient developed acute abdominal pain and bloody diarrhea. The white cell counts were elevated without left shift secondary to concomitant dexamethasone therapy. Clostridium difficile toxins and the stool cultures were both negative. CT of abdomen and pelvis with contrast revealed diffuse wall thickening of colon. Colonoscopy showed severe ischemic colitis sparing sigmoid colon and rectum. Multiple colon biopsies confirmed the diagnosis of severe ischemic colitis. Patient improved with conservative management and after discontinuation of paclitaxel therapy. There was no evidence of any cardiac sources of embolism. Conclusion: Paclitaxel is known to inhibit angiogenesis. This may cause alteration and dysfunction of the intestinal microvasculature, thus affecting innate immunity, leukocyte recruitment, coagulation and perfusion. These pathologic changes might contribute to the development of ischemic colitis. Once Clostridium difficile infection has been excluded, a diagnosis ofischemic colitis should be considered in cancer patients who are on paclitaxel therapy. Dose reduction or discontinuation of paclitaxel may control and prevent the recurrence of colitis.FigureFigure