Hydroxyurea associated ileocecal valve ulcer: evidence for causality

Abstract

A 73-year-old woman was referred for investigation of unexplained loss of appetite and loss of weight. She had a past medical history of essential thrombocythemia which was positive for JAK2 V617F mutation and was treated with hydroxyurea 1 g daily for 10 years. She was not on any other long-term medication. Her clinical examination was unremarkable apart from the presence of melanonychia. Her full blood count results were as following; hemoglobin of 11.6 g/dL, white cell counts of 5.1 × 10 9 /L and platelet counts of 335 × 10 9 /L. Her biochemical profile, coagulation profile, and serum inflammatory markers were all within normal limits. In view of her symptoms and advanced age, a colonoscopy was performed. The colonoscopy showed a clean based ulcer measuring 2.5 cm on the ileocecal valve (ICV), with normal mucosa in the terminal ileum and colon (Fig. 1). Histopathological assessment of the biopsies taken from the ulcer edge was consistent with active colitis and ulcerations with no diagnostic features