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Acute hemorrhagic colitis after oral administration of oseltamivir for influenza

2013; Elsevier BV; Volume: 77; Issue: 6 Linguagem: Inglês

10.1016/j.gie.2013.01.033

1097-6779

Yu‐Hung Chen, Huang-Jen Lai,

Hepatitis C virus research

Oseltamivir is an oral neuraminidase inhibitor used worldwide for the management of influenza. The most common adverse events are reported to be upper GI discomfort, including nausea and vomiting.1Nicholson K.G. Aoki F.Y. Osterhaus A.D. et al.Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial Neuraminidase Inhibitor Flu Treatment Investigator Group.Lancet. 2000; 355 (Erratum in: Lancet 2000 Nov 25;356:1856): 1845-1850Abstract Full Text Full Text PDF PubMed Scopus (688) Google Scholar, 2Treanor J.J. Hayden F.G. Vrooman P.S. et al.Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group.JAMA. 2000; 283: 1016-1024Crossref PubMed Scopus (912) Google Scholar Here we report an extremely rare adverse effect after oral oseltamivir.A 32-year-old woman presented with fever, cough, and myalgia with her family diagnosed to have type A influenza according to a rapid diagnostic kit. Empirical oral oseltamivir 75 mg twice daily was administered. She began to experience hematochezia and tenesmus after 2 days of treatment. A digital rectal examination revealed several masses in the entire circumferential mucosa of the rectum. Rectal neoplasm was suspected. Subsequent colonoscopy disclosed multiple patches of hemorrhagic colitis with central ulceration in the entire rectum (Fig. 1). Pathologic findings indicated ischemic colitis. After oral oseltamivir was discontinued, the symptoms soon resolved. Oseltamivir-induced acute hemorrhagic colitis is extremely rare; currently, we have found only 3 case reports describing this adverse effect.3Yoneda S. Kobayashi Y. Nunoi T. et al.Acute hemorrhagic colitis induced by the neuraminidase inhibitor oseltamivir.Nihon Shokakibyo Gakkai Zasshi. 2006; 103: 1270-1273PubMed Google Scholar, 4Matsushita M. Nishihara H. Nishiyama R. et al.Acute hemorrhagic colitis associated with oral administration of oseltamivir for the treatment of influenza A.J Infect Chemother. 2007; 13: 267-269Crossref PubMed Scopus (12) Google Scholar, 5Nakagawa Y. Nagai T. Okawara H. et al.Acute hemorrhagic colitis induced by the oral administration of oseltamivir used for influenza A treatment.Endoscopy. 2011; 43: E261Crossref PubMed Scopus (10) Google Scholar The scarce published reports all showed a positive result of the lymphocyte transformation test for oseltamivir, indicating oseltamivir-induced acute hemorrhagic colitis is an allergic drug reaction. In addition, the histopathologic findings showed characteristics of ischemic colitis that were characteristic in the literature and in our patient. Nakagawa et al5Nakagawa Y. Nagai T. Okawara H. et al.Acute hemorrhagic colitis induced by the oral administration of oseltamivir used for influenza A treatment.Endoscopy. 2011; 43: E261Crossref PubMed Scopus (10) Google Scholar also linked the ischemic cause of oseltamivir-induced hemorrhagic colitis to be allergic vasculitis. However, because of the small number of cases in the world, the detailed mechanism has not been clarified, and currently no laboratory test is available to predict this adverse event.In conclusion, although oral oseltamivir is still widely used to treat acute influenza, and the adverse effects were mostly mild, clinicians should always be alert for oseltamivir-induced hemorrhagic colitis when prescribing oseltamivir for patients with influenza. Oseltamivir is an oral neuraminidase inhibitor used worldwide for the management of influenza. The most common adverse events are reported to be upper GI discomfort, including nausea and vomiting.1Nicholson K.G. Aoki F.Y. Osterhaus A.D. et al.Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial Neuraminidase Inhibitor Flu Treatment Investigator Group.Lancet. 2000; 355 (Erratum in: Lancet 2000 Nov 25;356:1856): 1845-1850Abstract Full Text Full Text PDF PubMed Scopus (688) Google Scholar, 2Treanor J.J. Hayden F.G. Vrooman P.S. et al.Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group.JAMA. 2000; 283: 1016-1024Crossref PubMed Scopus (912) Google Scholar Here we report an extremely rare adverse effect after oral oseltamivir. A 32-year-old woman presented with fever, cough, and myalgia with her family diagnosed to have type A influenza according to a rapid diagnostic kit. Empirical oral oseltamivir 75 mg twice daily was administered. She began to experience hematochezia and tenesmus after 2 days of treatment. A digital rectal examination revealed several masses in the entire circumferential mucosa of the rectum. Rectal neoplasm was suspected. Subsequent colonoscopy disclosed multiple patches of hemorrhagic colitis with central ulceration in the entire rectum (Fig. 1). Pathologic findings indicated ischemic colitis. After oral oseltamivir was discontinued, the symptoms soon resolved. Oseltamivir-induced acute hemorrhagic colitis is extremely rare; currently, we have found only 3 case reports describing this adverse effect.3Yoneda S. Kobayashi Y. Nunoi T. et al.Acute hemorrhagic colitis induced by the neuraminidase inhibitor oseltamivir.Nihon Shokakibyo Gakkai Zasshi. 2006; 103: 1270-1273PubMed Google Scholar, 4Matsushita M. Nishihara H. Nishiyama R. et al.Acute hemorrhagic colitis associated with oral administration of oseltamivir for the treatment of influenza A.J Infect Chemother. 2007; 13: 267-269Crossref PubMed Scopus (12) Google Scholar, 5Nakagawa Y. Nagai T. Okawara H. et al.Acute hemorrhagic colitis induced by the oral administration of oseltamivir used for influenza A treatment.Endoscopy. 2011; 43: E261Crossref PubMed Scopus (10) Google Scholar The scarce published reports all showed a positive result of the lymphocyte transformation test for oseltamivir, indicating oseltamivir-induced acute hemorrhagic colitis is an allergic drug reaction. In addition, the histopathologic findings showed characteristics of ischemic colitis that were characteristic in the literature and in our patient. Nakagawa et al5Nakagawa Y. Nagai T. Okawara H. et al.Acute hemorrhagic colitis induced by the oral administration of oseltamivir used for influenza A treatment.Endoscopy. 2011; 43: E261Crossref PubMed Scopus (10) Google Scholar also linked the ischemic cause of oseltamivir-induced hemorrhagic colitis to be allergic vasculitis. However, because of the small number of cases in the world, the detailed mechanism has not been clarified, and currently no laboratory test is available to predict this adverse event. In conclusion, although oral oseltamivir is still widely used to treat acute influenza, and the adverse effects were mostly mild, clinicians should always be alert for oseltamivir-induced hemorrhagic colitis when prescribing oseltamivir for patients with influenza.