Ischemic colitis diagnosed by magnetic resonance imaging during lenalidomide treatment in a patient with relapsed multiple myeloma.
BACKGROUND
Multiple myeloma is the second most common hematological neoplasm that also affects young patients. The progression-free survival after autologous stem cell transplant has improved with the introduction of several novel agents such as lenalidomide, which may, however, increase the risk of adverse events.


METHODS
We describe the case of a 54-year-old woman with relapse of multiple myeloma 3 years after myeloablative allogeneic stem cell transplant who developed abdominal pain and bloody diarrhea following 7 months of lenalidomide therapy.


RESULTS
Abdominal plain x-ray and magnetic resonance imaging (MRI) without intravenous contrast material showed left-sided and splenic flexure acute ischemic colitis with reperfusion phenomena. Continuous intravenous infusion of unfractionated heparin was given with metronidazole and meropenem and the patient improved within a few days. MRI performed 15 days later confirmed complete recovery of ischemic colitis.


CONCLUSIONS
To our knowledge there have been no previously reported cases of ischemic colitis during lenalidomide therapy as a single agent in relapsed or refractory multiple myeloma, in particular promptly diagnosed by MRI.
Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena - Italy.
Susanna
S
Guerrini
Stem Cell Transplant and Cellular Therapy Unit, Azienda Ospedaliera Universitaria Senese, Siena - Italy.
Alessandro
A
Bucalossi
Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena - Italy.
Nevada
N
Cioffi Squitieri
Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena - Italy.
Francesco G
FG
Mazzei
Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena - Italy.
Luca
L
Volterrani
Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena - Italy.
Maria Antonietta
MA
Mazzei
D000890:Anti-Infective Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017091:Colitis, Ischemic / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D000077269:Lenalidomide; D008279:Magnetic Resonance Imaging; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D009364:Neoplasm Recurrence, Local; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D008795:Metronidazole; D013792:Thalidomide; D006493:Heparin; D000077269:Lenalidomide