Clopidogrel-Induced Eosinophilic Colitis

Abstract

Eosinophilic colitis is a rare condition characterized by histologic findings of high eosinophilic infiltrate in the gut wall, typically presenting with diarrhea and abdominal pain. The etiology of this entity remains unclear because it can be primary or can occur secondarily to infections, drugs, or even in association with immune-mediated diseases. We present the case of a woman referred to our outpatient clinic for chronic diarrhea that had been worsening for months. Colonoscopy with biopsies was performed, and eosinophilic colitis associated with the use of clopidogrel was diagnosed. After clopidogrel discontinuation, a complete remission of the clinical and histological picture was observed.

Keywords: antiplatelet drugs; eosinophilic gastrointestinal disease; histology.

Figure 1.

Normal mucosa appearance in the (A) sigmoid, (B) ascending, (C) transverse, and (D) cecum colon.

Figure 2.

(A and B) A hematoxylin and eosin-stained section of the large bowel mucosa obtained from the first colonoscopy. Biopsies are from the transverse colon showing numerous eosinophils in the lamina propria as well as in the surface and crypt epithelium. Scale bar 50 μm (A) and 25 μm (B). (C and D) Hematoxylin and eosin-stained sections of biopsies from the descending colon obtained during the second colonoscopy, after clopidogrel suspension, showing marked reduction of lamina propria eosinophils; these are rare and are never associated with crypts or surface epithelium. Scale bar 50 μm (A) and 25 μm (B).