title: Hydroxyurea and colonic ulcers: a case report.
abstract: BACKGROUND
  Hydroxyurea at a relatively low dose is frequently prescribed to induce hemoglobin F production in patients with sickle cell and β-thalassemia diseases because of its good efficacy and safety profiles. However, a potentially fatal gastrointestinal ulceration was recently found and herein reported.
  
  
  METHODS
  A thirty-seven-year-old man with transfusion dependent hemoglobin E/β-thalassemia disease was treated with hydroxyurea to induce hemoglobin F production since 2007 without incident. From 2008 to April 2010, episodes of hematochezia, mucous diarrhea and epigastric pain intermittently manifested. Four colonoscopies done during the period repeatedly showed ulcerative lesions from the terminal ileum to the ascending colon with a non-specific histo-pathologic finding. Subsequently, ulcerative lesions also developed at the pharynx, histo-pathologic findings of which were not different from those in the colon. These ulcerative lesions resolved within a month after discontinuing hydroxyurea in April 2010 and have not recurred since.
  
  
  CONCLUSIONS
  The findings suggested role of hydroxyurea in the pathogenesis of these ulcers, and that it must be immediately discontinued to prevent further damage to the digestive mucosa.
authors.forename: Kochawan
authors.initials: K
authors.lastname: Boonyawat
authors.affiliation: Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. sww563@hotmail.com.
authors.forename: Sansanee
authors.initials: S
authors.lastname: Wongwaisayawan
authors.forename: Prawat
authors.initials: P
authors.lastname: Nitiyanant
authors.forename: Vichai
authors.initials: V
authors.lastname: Atichartakarn
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000139:chemically induced*; D006801:Humans; D006918:Hydroxyurea / Q000009:adverse effects*; D008297:Male; D019384:Nucleic Acid Synthesis Inhibitors / Q000009:adverse effects*; D019226:Oral Ulcer / Q000139:chemically induced*; D014456:Ulcer / Q000139:chemically induced*; D017086:beta-Thalassemia / Q000188:drug therapy*
chemical_list: D019384:Nucleic Acid Synthesis Inhibitors; D006918:Hydroxyurea
references.citation: Oncologist. 1998;3(6):446-451
references.pmid: 10388137
references.citation: J Clin Invest. 1984 Aug;74(2):652-6
references.pmid: 6205021
references.citation: J Laryngol Otol. 2000 Dec;114(12):976-7
references.pmid: 11177373
references.citation: Indian J Dent Res. 2011 Nov-Dec;22(6):869-70
references.pmid: 22484890
references.citation: Ann Hematol. 2006 Mar;85(3):164-9
references.pmid: 16389564
references.citation: Singapore Med J. 1997 Jul;38(7):283-4
references.pmid: 9339092
references.citation: Clin Exp Dermatol. 2001 Mar;26(2):141-8
references.pmid: 11298103
references.citation: Arch Dermatol. 1999 Jul;135(7):818-20
references.pmid: 10411157
references.citation: J Am Acad Dermatol. 1991 Sep;25(3):518-24
references.pmid: 1918491
references.citation: Hum Pathol. 2007 Apr;38(4):527-36
references.pmid: 17367604
references.citation: Cancer Chemother Pharmacol. 1993;32(6):496-7
references.pmid: 8258201
references.citation: Acta Derm Venereol. 2011 May;91(3):373-4
references.pmid: 21336478
references.citation: J Dermatol. 1999 Jan;26(1):56-62
references.pmid: 10063214
references.citation: Blood. 2010 Mar 25;115(12):2354-63
references.pmid: 19903897