DELAYED CHRONIC DIARRHEA AND WEIGHT-LOSS POSSIBLY DUE TO TICLOPIDINE THERAPY

OBJECTIVE: To report a case of delayed-onset chronic diarrhea, anorexi a, and weight loss possibly complicating the use of ticlopidine. CASE SUMMARY: A 48-year-old white man presented with unremitting diarrhea a ssociated with anorexia and marked weight loss. His history was signif icant for transient ischemic attack, resistant hypertension, homocysti nemia, and chronic renal insufficiency. The patient had tolerated ticl opidine therapy for 2 years without problems, and there had been no ch anges in his drug regimen for several months. No abnormality was found on detailed digestive system evaluation and all symptoms and signs pr omptly resolved after ticlopidine therapy was discontinued. DISCUSSION : The occurrence of diarrhea early during ticlopidine therapy should m ake the clinician consider the drug as the most likely cause. However, the appearance of chronic diarrhea, anorexia, and weight loss years a fter a patient had tolerated the drug is less typical for ticlopidine. In such situations, if no other cause can be identified, cautious wit hdrawal of the drug should be considered. We believe that all the pati ent's symptoms reported here were likely due to ticlopidine. CONCLUSIO NS: Clinicians should be aware that the gastrointestinal adverse effec ts of ticlopidine may surface years after therapy is begun. The cause of ticlopidine-induced diarrhea remains unknown.