Non-steroidal anti-inflammatory drug-induced protein-loosing enteropathy complicated by intestinal obstruction
Introduction (case reports only) Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs in the world. Most frequent adverse events of NSAIDs are upper gastrointestinal damage and bleeding. Nevertheless, it is known NSAIDs may cause the damage of small and large intestine including ulcerations, stenosing and protein-loosing enteropathy. Case description (case reports only) A 47-year-old woman was admitted to the Gastroenterology Department due to more than 6 months lasting diarrhea, weakness and edemas of legs. Patient had history of long-term iron deficiency anemia and post-traumatic healing-resistant trophic ulcers of lower extremities. Because of the injury-related pain, she was constantly consuming Diclofenac for 8 years, even up to 10 tablets (150 mg per tablet) per day. Laboratory tests revealed hypoalbuminemia (12 g/l), hypoproteinemia (31,3 g/l) and iron deficiency anemia (Hb 106 g/l). Initial endoscopy and radiology investigations identified ulceration in the large intestine, thickened wall of terminal ileum, non-contradictory results of histological examination led to suspection of Crohn's disease (CD). Repeated full ileocolonoscopy revealed four ulcerated and fibrosing strictures located in the right part of the colon, therefore the endoscopic balloon dilation was applied and consideration of NSAID enteropathy occured. Treatment with the previously prescribed Mesalazine and NSAID treatment was discontinued. Unfortunately, patient's condition was complicated by intestinal obstruction, thus resection of 80 cm segment of small intestine was performed. Eventually, postoperative histopathological analysis of resection specimen excluded CD and, regarding clinical findings, NSAID enteropathy was confirmed. Summary (case reports only) In this clinical case we presented a patient with troublesome protein-loosing enteropathy, chronic diarrhea, non-healing trophic ulcers and history of long-term use of Diclofenac, who was diagnosed with NSAID-induced enteropathy. Disease caused strictures led to intestinal obstruction. Conclusions Intestinal lesions caused by NSAID misuse could be as severe as upper gastrointestinal damage. These medications should be prescribed rationally and used under supervision of a specialist.