Sevelamer-Induced Colitis Presenting as a Pseudotumor

Okwara, Chinemerem; Choi, Christie; Park, Jason

doi:10.1016/j.cgh.2015.02.015

Cited by 27 publications

(25 citation statements)

References 4 publications

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“…3 Okwara et al described a patient who presented with non-bloody diarrhea who was found to have a circumferential polypoid mass in the cecum. 4 Biopsy showed sevelamer crystals in association with necrosis and ischemic changes without evidence of dysplasia or malignancy, and the authors concluded that the mass formation was the result of sevelamer-induced colitis. 4 Herein, we describe the first case of a colon perforation due to sevelamer-associated ischemic colitis.…”

Section: Discussionmentioning

confidence: 99%

“…4 Biopsy showed sevelamer crystals in association with necrosis and ischemic changes without evidence of dysplasia or malignancy, and the authors concluded that the mass formation was the result of sevelamer-induced colitis. 4 Herein, we describe the first case of a colon perforation due to sevelamer-associated ischemic colitis. Sevelamer crystals were found in the ulcer exudate and within the colonic wall in areas of transmural necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The histologic features of sevelamer crystals were first described by Swanson et al in a case series of upper and lower gastrointestinal tract biopsy and resection specimens and were validated by submitting crushed sevelamer tablets for histologic examination. 2 They described the crystals as nonpolarizable with a broad irregularly-spaced fish scale pattern and a two-toned appearance consisting of bright pink accentuations with a rusty yellow background.…”

Section: Discussionmentioning

confidence: 99%

“…2 Subsequent cases of sevelamer-associated colonic mucosal injury presenting with hematochezia and of sevelamer-induced colitis with pseudotumor formation have been reported. 3,4 We would like to add to this small body of literature by reporting a case of sevelamer-associated ischemic colitis with perforation.…”

Section: Introductionmentioning

confidence: 99%

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Sevelamer-associated ischemic colitis with perforation

Hudacko

Kaye

2015

Gastroenterol Insights

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We present a case of an 83-year-old woman with end-stage renal disease and hyperphosphatemia treated with sevelamer carbonate, who underwent subtotal colectomy for diffuse bowel necrosis and two perforations in the transverse colon. Histologic examination revealed ischemic colitis with crystals consistent with sevelamer carbonate embedded in ulcer debris and within the colonic wall in areas of transmural necrosis. This is a novel cause of drug-induced ischemic colitis with subsequent perforation that has not yet been reported in the literature. Clinicians and pathologists should be aware of the potential complications of sevelamer use and the histologic features of sevelamer-induced colonic injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sevelamer-associated ischemic colitis with perforation

Hudacko

Kaye

2015

Gastroenterol Insights

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“…17 Subsequent reports have reported similar associations. [18][19][20][21][22][23][24] ATYPICAL MORPHOLOGY Nonclassical resin morphology represents a common diagnostic challenge. The most common resin pitfalls are discussed below.…”

Section: Classic Morphologymentioning

confidence: 99%

Challenges in Diagnosing Medication Resins in Surgical Pathology Specimens: A Crystal-Clear Review Guide

González¹,

Lagana²,

Szeto³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Medication resins, including Kayexalate, sevelamer, and bile acid sequestrants, can be encountered in gastrointestinal tract specimens. Their classic histologic appearances have been well documented, but pathologist recognition of the resins is 75%, patient history is not always available, and atypical morphologic findings are sometimes present. Objective.— To offer a succinct overview of resins in the gastrointestinal tract, including typical and atypical appearances, in order to serve as a quick reference guide. Data Sources.— The study comprises published literature, survey data, and our personal experiences. Conclusions.— Classic morphology is the benchmark for identifying these resins, but color, location, and fish scale pattern can deviate from the norm, making proper identification a challenge. Patient history should be sought whenever possible, and ancillary staining is an option when necessary. Additionally, the presence of resins should prompt the pathologist to search for potentially related diagnoses (namely, causes of diarrhea in patients on bile acid sequestrants and diagnoses associated with renal failure in patients on Kayexalate or sevelamer).

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Drug-Induced Injury, Vascular, Congenital, Motility, Polyps, and Miscellaneous Disorders

Chandan

2019

Surgical Pathology of Non-Neoplastic Gastrointestinal Diseases

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Sevelamer-Induced Colitis Presenting as a Pseudotumor

Cited by 27 publications

References 4 publications

Sevelamer-associated ischemic colitis with perforation

Sevelamer-associated ischemic colitis with perforation

Challenges in Diagnosing Medication Resins in Surgical Pathology Specimens: A Crystal-Clear Review Guide

Drug-Induced Injury, Vascular, Congenital, Motility, Polyps, and Miscellaneous Disorders

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