A rare complication with a single dose of alendronate.
The authors present a case of an 84-year-old patient who presented to the emergency department with sudden onset abdominal pain radiating to the neck. The patient's medication included warfarin, and alendronate, which was started by the general practitioner 2 days prior to presentation. Initial systemic examination and investigations, including chest x-ray, were unremarkable. Within 24 h of presentation the patient developed bilateral pneumonia with effusions. Due to continued clinical deterioration over the next 48 h, a CT thorax was performed that showed evidence of large oesophageal perforation with mediastinitis and gas in the mediastinum. The patient was treated with an expandable metal stent, bilateral chest drains, broad spectrum antibiotics, antifungals and total parenteral nutrition. Over a period of 8 weeks the patient made an excellent recovery. This rare case illustrates the importance of vigilance for the life-threatening complication of oesophageal perforation with alendronate treatment.
Department of Medicine, University Hospital of Wales, Cardiff, UK. spmunigoti@gmail.com
Srinivasa
S
Munigoti
Ricky
R
Frazer
Alan
A
Rees
Guy
G
Blackshaw
Gareth
G
Thomas
Aled
A
Roberts
D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004939:Esophageal Perforation / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D015607:Stents
D050071:Bone Density Conservation Agents; D019386:Alendronate