Taxane-Induced Colon Ischemia

Abstract

Introduction: Colitis is a rare but serious gastrointestinal complication associated with taxanebased chemotherapy and the mechanism is not well understood. The presented case reports colon ischemia as a possible mechanism for this side effect. A 57-year-old female presented with acute onset of abdominal pain and few episodes of bloody diarrhea for 5 days. The pain was cramping, sharp, central, and with nausea and anorexia. Formed normal stools changed to loose and blood tinged stools. No vomiting, tenesmus, fever, or melena was reported. She was diagnosed with rightsided breast cancer 2 months ago ago (s/p lumpectomy) and was started on adjuvant chemotherapy with TCH (Docetaxel, Carboplatin, Transtuzumab) 6 days prior to admission. PMH: renal cancer (s/p nephrectomy), breast cancer, HTN, hypercholesterolemia, and chronic back pain. Home medications were TCH, Percocet, Nasonex, Nexium, Crestor, Benicar. SH: smoked 1PPD. Physical exam was significant for tachycardia and mild diffuse abdominal tenderness without guarding and rebound, and normal bowel sounds. Labs showed WBC of 3.6, stable H&H, and normal liver tests. Stool WBC, culture, AFB smear and culture, C.diff and HIV tests were negative. Colonic wall thickness at transverse colon and parts of ascending and descending colon was seen in the imaging. Colonoscopy showed linear ulcers with mucosal edema of transverse colon (Figure 1) and the pathology results showed ischemia and ulceration (Figure 2). Final diagnosis of pharmacologically mediated colon ischemia was made.Figure 1: Colonoscopy showing ischemia in transverse colon.Figure 2: Pathology results showing ischemia.Conclusion: Ischemia may play a role in taxane-associated collitis, as taxanes are known to be antiangiogenic agents. This may be attributable to the direct cytotoxic effect on mucosal cells.