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At presentation our patient was afebrile and hemodynamically stable. Her abdomen was soft but diffusely tender to palpation. She exhibited voluntary guarding without rebound tenderness. Her white blood cell count was elevated, 19.

All other laboratory studies were normal (Table dioxin. Her abdominal and pelvic axial computed tomography scans with oral and intravenous contrast revealed diffuse wall thickening isolated to the left colon, consistent with acute colitis.

Bromfenac Ophthalmic Solution (Xibrom)- Multum her stay in the ED the patient received 2 mg of hydromorphone and 4 mg of ondansetron, which reduced her abdominal pain pegfilgrastim 8 of 10.

She was diagnosed with colitis of undetermined etiology, discharged from the hospital, and prescribed 10 days of levofloxacin and metronidazole and hydrocodone-acetaminophen for pain. Her discharge instructions stated that she may continue to take her home medications as previously procedia computer science bica, including sumatriptan. The patient continued to have abdominal pain and a severe headache. Within hours of returning home from the ED she sought care from her family procedia computer science bica. She was promptly procedia computer science bica and admitted to the hospital for intravenous procedia computer science bica management and a gastroenterology consult.

She was prescribed bowel rest, intravenous hydration, morphine for pain control, and levofloxacin. A neurologist was procedia computer science bica consulted because of her procedia computer science bica headache. The neurologist recommended administering intravenous dexamethasone and valproic acid.

The combination of these 2 agents produced complete headache resolution within 2 hours. Her headache did not return during the course of her hospitalization.

During the next 72 hours the patient's abdominal pain and nausea slowly improved, and they were resolved procedia computer science bica the time of discharge. Her white blood cell count also normalized. She tolerated the bowel preparation regimen without complication. Direct visualization of the sigmoid colon revealed a granular and erythematous appearance lacking ulceration or pseudomembrane.

A biopsy was consistent with procedia computer science bica colitis procedia computer science bica evidence of crypt architectural distortion or destruction. Serologic markers for inflammatory bowel disease (IBD), perinuclear antineutrophil cytoplasmic antibodies and antisaccharomyces cerevisiae antibodies, were negative.

The presence or absence of these markers is not diagnostic for IBD but is useful in distinguishing Crohn disease from ulcerative colitis. Patients with Crohn disease are more likely to be positive for perinuclear antineutrophil cytoplasmic antibodies and negative for saccharomyces cerevisiae antibodies. The opposite is true for patients with ulcerative procedia computer science bica. Ischemic colitis is a consequence of decreased arterial blood flow to the colon.

It is associated with numerous disease processes and medications. Common pharmaceutical agents known to induce ischemic colitis include antihypertensives, nonsteroidal anti-inflammatory drugs, digoxin, oral contraceptives, pseudoephedrine, vasoconstrictors (ie, ergotamine products), and alosetron. A 1998 case series identified 8 cases of ischemic colitis potentially related to sumatriptan. All of the patients presented with abdominal pain and hematochezia.

Detailed information existed for only 2 of the 8 patients. Both were smokers and had long histories of chronic gastrointestinal issues before the use of sumatriptan. A more recent case described ischemic colitis in a 52-year-old woman.

She too experienced hematochezia. Two other published cases have reported an association between naratriptan use and ischemic colitis. The other case involved a 52-year-old woman. Again, both of these patients presented with abdominal pain and hematochezia.

In addition procedia computer science bica potentially neurologia ischemic colitis, there have been other published reports of sumatriptan causing mesenteric ischemia. First, the patient is the youngest reported to date in the literature.

Next, the patient lacked risk factors for vascular disease, including tobacco or oral contraceptive use. Although she did take one dose of ibuprofen, the likelihood of this medication inducing colitis is very low, as previously published reports of nonsteroidal anti-inflammatory drug-related ischemic colitis involved patients over the age of 49 who took the medication for at least 3 continuous days.

A variety of diagnostic modalities may be used to assist in the diagnosis of ischemic colitis. Colonoscopy is considered the primary tool. Direct visualization reveals edema, erythema, submucosal hemorrhage, and epithelial necrosis. A common differential diagnosis includes infectious colitis, procedia computer science bica bowel disease, neoplasm, and diverticulitis. Twenty percent of patients will require surgical intervention. Although most patients will not have a recurrence of their symptoms, some patients may develop chronic colitis with the potential for stricture formation.

She has had no further episodes of colitis. She continues bayer logos have intermittent migraine headaches that she safely treats procedia computer science bica sumatriptan. She has received strict guidance not to exceed the Food and Drug Administration-approved maximum daily dose for this medication. Her headache procedia computer science bica has decreased with the combined use of topiramate and periodic acupuncture.

This case illustrates a potential severe complication of these medications in a patient not considered to be at risk for vascular disease.

Although this patient escaped without long-term sequelae, ischemic colitis can result in significant morbidity. This case is important for 2 reasons. First, the incidence of this unintended consequence of 5-HT 1 receptor agonist therapy needs to be elucidated.



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