Severe eosinophilic colitis caused by neuropathic agents in a patient with chronic fatigue syndrome and functional abdominal pain: case report and review of the literature

Konstantinos C. Fragkos; John Barragry; Charisma Shahi Fernando; Marco Novelli; Joanna Begent; Natalia Zárate-Lopez

doi:10.1055/a-0596-7981

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2018; 56(06): 573-577
DOI: 10.1055/a-0596-7981

Kasuistik

Severe eosinophilic colitis caused by neuropathic agents in a patient with chronic fatigue syndrome and functional abdominal pain: case report and review of the literature

Schwere eosinophile Kolitis durch medikamentöse Therapie neuropathischer Schmerzen bei Patientin mit chronischem Erschöpfungssyndrom und funktionellen abdominalen Schmerzen: Ein Fallbericht

Konstantinos C. Fragkos

¹GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

,

John Barragry

¹GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

,

Charisma Shahi Fernando

²Histopathology Department, University College London Hospitals NHS Foundation Trust, London United Kingdom

,

Marco Novelli

²Histopathology Department, University College London Hospitals NHS Foundation Trust, London United Kingdom

,

Joanna Begent

³Adolescent Unit, University College London Hospitals NHS Foundation Trust, London United Kingdom

,

Natalia Zárate-Lopez

¹GI Physiology Unit, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

› Author Affiliations

Abstract

Eosinophilic colitis is a rare clinical condition that belongs to the group of eosinophilic gastrointestinal disorders. Its occurrence can be primary or secondary to infection, medications, or autoimmune/hematological conditions. We present a case of a young female adult with severe chronic fatigue syndrome, widespread chronic pain, including functional abdominal pain, who developed severe eosinophilic colitis following successive treatments with gabapentin and pregabalin. On both occasions, symptoms manifested as abdominal pain, diarrhea, and eosinophilia and improved upon discontinuation of the medications. Magnetic resonance imaging of the small bowel demonstrated an ascending colon colitis, and endoscopic investigations confirmed florid colitis mainly in the ascending colon with biopsies demonstrating a dense eosinophilic infiltrate with micro-abscesses. Serum eosinophil counts correlated well with the timing of the agents’ administration. There was no other organ involvement. Symptoms improved upon discontinuation of the drugs and steroid administration. Eosinophilic colitis is an exceptionally rare entity and its mechanism of action is still unclear. Suspicion of eosinophilic colitis should be raised if a patient presents with abdominal pain, diarrhea, and peripheral eosinophilia following treatment with pregabalin or gabapentin.

Zusammenfassung

Die eosinophile Kolitis ist eine sehr seltene Krankheit aus der Gruppe der eosinophilen Magen-Darm-Erkrankungen. Als Auslöser gelten Primär- und Sekundärinfektionen, Medikamente, sowie autoimmune und hämatologische Erkrankungen. Unser Fall beschreibt eine junge, weibliche Erwachsene mit schwerem chronischem Müdigkeitssyndrom und generalisierten chronischen Schmerzen, darunter funktionellen Unterleibsschmerzen, welche unter Behandlung mit Gabapentin und Pregabalin an einer schweren eosinophilen Kolitis erkrankte. Zu zwei unterschiedlichen Zeitpunkten wies die Patientin abdominelle Schmerzen, Diarrhoe und ein Eosinophilie auf, mit jeweils Verbesserung der Symptomatik nach Sistieren der Medikamenteneinnahme. In einer Kernspintomografie stellte sich eine Kolitis des aufsteigenden Kolons dar. Endoskopisch konnte eine floride Kolitis, vorwiegend im Kolon ascendens, bestätigt werden, mit Nachweis einer dichten eosinophilen Infiltration mit Mikroabszessen in den Biopsien. Die serologische Eosinophilie korrelierte zeitlich mit der Medikamenteneinnahme. Andere Organe waren nicht beteiligt. Die Symptomatik verbesserte sich nach Absetzen der Medikamente und Verabreichung von Steroiden. Die eosinophile Kolitis ist eine ausgesprochen seltene Erkrankung mit bisher noch unklarem Wirkmechanismus. Bei Patienten mit abdominellen Schmerzen, Diarrhoe und peripherer Eosinophilie unter einer Therapie mit Pregabalin oder Gabapentin sollte der Verdacht auf eine eosinophile Kolitis gestellt werden.

Key words

gabapentin - pregabalin - eosinophilic colitis - myalgic encephalopathy - functional bowel disorder

Schlüsselwörter

Gabapentin - Pregabalin - Eosinophile Kolitis - Myalgische Enzephalomyelitis - Weiterbildung - funktionelle Magen-Darm-Erkrankung

Full Text

References

References
1 Shifflet A, Forouhar F, Wu GY. Eosinophilic digestive diseases: eosinophilic esophagitis, gastroenteritis, and colitis. J Formos Med Assoc 2009; 108: 834-843
2 Okpara N, Aswad B, Baffy G. Eosinophilic colitis. World J Gastroenterol 2009; 15: 2975-2979
3 Uppal V, Kreiger P, Kutsch E. Eosinophilic gastroenteritis and colitis: a comprehensive review. Clin Rev Allergy Immunol 2016; 50: 175-188
4 Dionisio de Sousa IJ, Bonito N, Pais A. et al. Eosinophilic colitis. BMJ Case Rep 2016;
5 Yozgat A, Colak A, Koseoglu HT. et al. Eosinophilic colitis under etanercept. Acta Gastroenterol Belg 2015; 78: 439-440
6 Alfadda AA, Storr MA, Shaffer EA. Eosinophilic colitis: epidemiology, clinical features, and current management. Therap Adv Gastroenterol 2011; 4: 301-309
7 Spriet S, Banks TA. Drug reaction with eosinophilia and systemic symptoms syndrome. Allergy Asthma Proc 2015; 36: 501-505
8 Shiohara T, Kano Y. Drug reaction with eosinophilia and systemic symptoms (DRESS): incidence, pathogenesis and management. Expert Opin Drug Saf 2017; 16: 139-147
9 Roujeau JC, Dupin N. Virus reactivation in drug reaction with eosinophilia and systemic symptoms (DRESS) results from a strong drug-specific immune response. J Allergy Clin Immunol Pract 2017; 5: 811-812
10 Eshki M, Allanore L, Musette P. et al. Twelve-year analysis of severe cases of drug reaction with eosinophilia and systemic symptoms: a cause of unpredictable multiorgan failure. Arch Dermatol 2009; 145: 67-72
11 Jensen ET, Martin CF, Kappelman MD. et al. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr 2016; 62: 36-42
12 Franco AI, Escobar L, Garcia XA. et al. Mesalazine-induced eosinophilic pneumonia in a patient with ulcerative colitis disease: a case report and literature review. Int J Colorectal Dis 2016; 31: 927-929
13 Kocak G, Kocak E, Akbal E. et al. Eosinophilic colitis: a rare cause of lower gastrointestinal bleeding in an elderly adult. J Am Geriatr Soc 2014; 62: 2016-2017
14 Farooqi A. Eosinophilic colitis mimicking caecal malignancy. J Ayub Med Coll Abbottabad 2014; 26: 408-409
15 Alfadda AA, Shaffer EA, Urbanski SJ. et al. Eosinophilic colitis is a sporadic self-limited disease of middle-aged people: a population-based study. Colorectal Dis 2014; 16: 123-129
16 Smith MT, Moore BJ. Pregabalin for the treatment of fibromyalgia. Expert Opin Pharmacother 2012; 13: 1527-1533
17 Arnold LM, Clauw DJ, Dunegan LJ. et al. A framework for fibromyalgia management for primary care providers. Mayo Clin Proc 2012; 87: 488-496
18 Gale JD, Houghton LA. Alpha 2 delta (α(2)δ) ligands, gabapentin and pregabalin: what is the evidence for potential use of these ligands in irritable bowel syndrome. Front Pharmacol 2011; 2: 28
19 Ragucci MV, Cohen JM. Gabapentin-induced hypersensitivity syndrome. Clin Neuropharmacol 2001; 24: 103-105
20 Goldman J, Duval-Modeste AB, Musette P. et al. Drug-induced hypersensitivity syndrome due to gabapentin. Ann Dermatol Venereol 2008; 135: 230-232
21 Bamanikar A, Dhobale S, Lokwani S. Pregabalin hypersensitivity in a patient treated for postherpetic neuralgia. Indian J Pharmacol 2013; 45: 522-523
22 Lasso-de-la-Vega MC, Zapater P, Such J. et al. Gabapentin-associated hepatotoxicity. Am J Gastroenterol 2001; 96: 3460-3462
23 Dogan S, Ozberk S, Yurci A. Pregabalin-induced hepatotoxicity. Eur J Gastroenterol Hepatol 2011; 23: 628
24 Sendra JM, Junyent TT, Pellicer MJ. Pregabalin-induced hepatotoxicity. Ann Pharmacother 2011; 45: e32
25 Richardson CE, Williams DW, Kingham JG. Gabapentin induced cholestasis. BMJ 2002; 325: 635
26 Wouters MM, Vicario M, Santos J. The role of mast cells in functional GI disorders. Gut 2016; 65: 155-168
27 Kim SE, Chang L. Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms?. Neurogastroenterol Motil 2012; 24: 895-913
28 Spergel JM, Rothenberg ME, Collins MH. et al. Reslizumab in children and adolescents with eosinophilic esophagitis: results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 2012; 129: 456-463