An Unusual Case of Colon Perforation With Multiple Transmural Ulcers After Use of Polmacoxib and Everolimus in a Metastatic Breast Cancer Patient

Abstract

Everolimus (Afinitor) is an inhibitor of mammalian target of rapamycin. Polmacoxib (Acelex) is a nonsteroidal anti-inflammatory drug that belongs to the cyclooxygenase-2 (COX-2) inhibitor family and is mainly used for treatment of arthritis. Intestinal perforation has not been reported previously as a complication of everolimus, and perforation of the lower intestinal tract caused by a selective COX-2 inhibitor is extremely rare. We present here a case of colon perforation that occurred after use of polmacoxib in a metastatic breast cancer patient who had been treated with everolimus for the preceding six months.

Keywords: Colon perforation; Everolimus; Polmacoxib, Nonsteroidal anti-inflammatory agents; mTOR inhibitor.

Fig. 1.

Abdominopelvic computed tomography scan showed multiple wall defects of the descending colon with perilesional fat infiltration (A, yellow arrow) and pneumoperitoneum (B, perihapatic free air), suggesting multiple perforations of the descending colon.

Fig. 2.

Multiple ulcerations (yellow circles) in the delivered specimen.

Fig. 3.

Pathologic evaluation of the specimen using H&E stain, showing chronic active transmural inflammation (A, B, D), vascular congestion (C), and acute serositis (A).

Fig. 4.

Emergency sigmoidoscopy showed multiple geographic ulcers (A) in the remnant colonic wall (B).

Fig. 5.

Ulcerations of the colon wall self-resolved, and remnant colonic mucosa was normal in colonoscopy 6 months after surgery. (A) Sigmoid colon which was severely ulcerated in the past, (B) anastomosis site.