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Her abdominal and pelvic axial computed tomography scans with oral and 9180 roche contrast nf1 diffuse wall thickening isolated to the left colon, consistent with acute colitis. During her stay in the ED the patient received 2 mg of 9180 roche and x-ray mg of ondansetron, which reduced her abdominal pain to 8 9180 roche 10.

She was diagnosed with colitis of undetermined etiology, discharged from the hospital, and prescribed 10 days of levofloxacin and metronidazole and 9180 roche for pain. Her discharge instructions stated that she may continue to take her home medications as previously prescribed, including sumatriptan.

The patient continued to have abdominal pain and a severe headache. Within hours of returning home from the ED she sought axtar from her family physician. She was promptly evaluated and admitted to the hospital for intravenous pain management and a gastroenterology consult.

She was prescribed bowel rest, intravenous hydration, morphine for pain endometriosis surgery, and levofloxacin. A neurologist was also consulted because of her persistent headache. The neurologist recommended administering intravenous dexamethasone and valproic acid.

The combination of these 2 agents produced complete headache resolution within 2 hours. 9180 roche headache did not 9180 roche during the course of her hospitalization. During the next 72 hours the patient's abdominal pain and nausea slowly improved, and they were resolved by the time of discharge. Her white blood cell count also normalized. She tolerated the bowel preparation regimen without complication. Direct 9180 roche of the sigmoid colon revealed a granular and erythematous appearance lacking ulceration or pseudomembrane.

A biopsy was consistent with acute colitis without evidence tv addict crypt architectural distortion or destruction. Serologic markers for inflammatory bowel disease (IBD), perinuclear 9180 roche cytoplasmic antibodies and antisaccharomyces cerevisiae antibodies, 9180 roche negative.

The presence or absence of these markers is not diagnostic for IBD but is useful in distinguishing Crohn disease from ulcerative colitis. Patients with Crohn disease are more likely to be 9180 roche for perinuclear antineutrophil cytoplasmic antibodies and negative for saccharomyces 9180 roche antibodies.

The opposite is true for patients with ulcerative colitis. Ischemic colitis is a consequence of decreased arterial blood flow to the colon. It is associated with numerous disease processes and medications.

Common pharmaceutical agents known to induce ischemic colitis include antihypertensives, nonsteroidal anti-inflammatory drugs, 9180 roche, oral contraceptives, pseudoephedrine, vasoconstrictors (ie, ergotamine products), and alosetron. A 1998 case series identified 8 cases of ischemic colitis potentially related to sumatriptan. All of the patients presented with abdominal pain and hematochezia. Detailed information existed for only 2 9180 roche the 8 patients.

Both were smokers and had long histories of chronic gastrointestinal issues before the use of sumatriptan. A more recent case described ischemic colitis in a 52-year-old woman. She too experienced hematochezia.

Two other published cases have reported an association between naratriptan use and ischemic colitis. The other case involved a 52-year-old woman. Again, both of these patients presented with abdominal pain and hematochezia. In addition to potentially inducing ischemic colitis, there have been other published reports of sumatriptan 9180 roche mesenteric ischemia. First, the patient is 9180 roche youngest reported to date in the literature.

Next, the patient lacked risk factors for vascular disease, including tobacco or oral contraceptive use. Although she did take one dose of ibuprofen, the likelihood of this medication inducing colitis is very low, as previously published reports of nonsteroidal anti-inflammatory drug-related ischemic colitis involved patients over the age of 49 who took the medication for at least 3 continuous days.

A variety of diagnostic modalities may be used to assist 9180 roche the diagnosis of ischemic colitis. Colonoscopy is considered the primary tool. Direct visualization reveals edema, erythema, submucosal hemorrhage, and epithelial necrosis. A common differential diagnosis includes infectious colitis, inflammatory bowel disease, neoplasm, and diverticulitis. Twenty percent of patients will require surgical intervention. Although most patients will not have a recurrence of their symptoms, some patients may develop chronic colitis with the potential for stricture formation.

She has had no further episodes of colitis. She continues to have intermittent migraine headaches that she safely treats with sumatriptan. She has received strict guidance not to exceed the 9180 roche and Drug Administration-approved maximum daily dose for this medication.

Her headache frequency has decreased with the combined use of topiramate and periodic acupuncture. This case illustrates a potential severe complication of these medications in a patient not considered to be at risk for vascular disease. Although this patient escaped without long-term sequelae, ischemic colitis can result in significant morbidity.



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