title: Crystal-Associated Colitis with Ulceration Leading to Hematochezia and Abdominal Pain.
abstract: Lower GI bleeding is a common cause for hospitalization in adults. Medication-associated mucosal injury is an important clinical entity that can result in significant morbidity and mortality. We present the case of a 45-year-old woman with a 3-month history of intermittent abdominal cramping and rectal bleeding. Her medical history was extensive and included end-stage renal disease and a remote history of endometrial carcinoma that was treated with radiation. Initial workup was concerning for ischemic and radiation colitis, however, histology was most consistent with acute inflammation and ulceration associated with crystal fragments. Sevelamer and cholestyramine are commonly used ion-exchange resins that have been associated with mucosal damage. Both medications were discontinued and her symptoms resolved. Our case highlights an underrecognized but important cause of hematochezia.
authors.affiliation: Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pa., USA.
authors.forename: Meeta
authors.initials: M
authors.lastname: Desai
authors.affiliation: Department of Internal Medicine, Pinnacle Health, Harrisburg, Pa., USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Reiprich
authors.affiliation: Department of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, Pa., USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Khov
authors.affiliation: Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, Pa., USA.
authors.forename: Zhaohai
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, Pa., USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Mathew
authors.affiliation: Department of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, Pa., USA.
authors.forename: John
authors.initials: J
authors.lastname: Levenick
keywords: Cholestyramine; Crystal deposition; Hematochezia; Sevelamer; Ulceration