Ischemic colitis associated with paclitaxel

Systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. This report describes the case of a 49-yea r-old woman with liver metastases from a neuroendocrine tumor of unknown or igin who developed mild ischemic colitis after chemotherapy with carboplati n and paclitaxel. The patient developed symptoms of gastrointestinal toxici ty with abdominal pain and bloody diarrhea, which resolved in about 10 days . She had a normal white blood cell count throughout her illness; the assay of stool specimens for Clostridium difficile toxins and the stool cultures were both negative. A sigmoidoscopy showed a mild, transient ischemic coli tis, which was confirmed by pathologic examination of the biopsy specimens. Although carboplatin is not related to severe colonic cytotoxicity, it has been previously reported that paclitaxel induces necrosis of the gastroint estinal mucosa and inhibits angiogenesis. Pseudomembranous colitis is the m ost frequent complication in patients with cancer who undergo paclitaxel-ba sed chemotherapy and develop gastrointestinal toxicity. Once C. difficile i nfection has been excluded, a diagnosis of ischemic colitis should be consi dered, especially in patients with cancer who have normal white blood cell counts.