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Case Reports
. 2024 Oct 15;16(10):e71523.
doi: 10.7759/cureus.71523. eCollection 2024 Oct.

Sodium Polystyrene Sulfonate-Induced Massive Bowel Necrosis With Distant Extraintestinal Crystal Deposition: A Case Report and Review of the Literature

Affiliations
Case Reports

Sodium Polystyrene Sulfonate-Induced Massive Bowel Necrosis With Distant Extraintestinal Crystal Deposition: A Case Report and Review of the Literature

Nebojsa Brezic et al. Cureus. .

Abstract

Sodium polystyrene sulfonate (SPS), a cation-exchange resin, has been a mainstay in long-term hyperkalemia management but is associated with significant gastrointestinal complications, particularly when used with sorbitol. The deposition of SPS crystals within the intestinal mucosa has been suggested to precipitate ischemia, necrosis, and ulcerations, ultimately leading to bowel perforation. This case report details a striking instance of massive bowel perforation subsequent to SPS administration, with accompanying findings of disseminated crystals in distant organs and tissues upon autopsy. Additionally, we provide a comprehensive review of the existing literature on this rare yet significant drug-induced side effect.

Keywords: autopsy findings; bowel perforation; cation-exchange resin; drug-induced bowel injury; extraintestinal crystal deposition; sodium polystyrene sulfonate.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Extensive necrosis involving both the small and large bowel.
Figure 2
Figure 2. SPS crystal deposition in: small intestine mucosa with associated necrosis and fibrinopurulence at the site of perforation (A), large intestine with associated necrosis (B), gastroesophageal junction with associated fibrinopurulence (C) and muscularis of the stomach (D), H&E stain.
SPS: sodium polystyrene sulfonate; H&E: hematoxylin and eosin
Figure 3
Figure 3. Systemic SPS crystal deposition in: (A) gallbladder mucosa, (B) urinary bladder, (C) peri-pancreatic adipose tissue, (D) peri-appendiceal adipose tissue, (E) peri-subcarinal lymph node adipose tissue, (F) thyroid gland follicles, and (G) skeletal muscle fibers, H&E stain.
SPS: sodium polystyrene sulfonate; H&E: hematoxylin and eosin
Figure 4
Figure 4. Typical "fish-scale" texture of SPS crystals on high magnification, H&E stain (A). AFB staining showcasing SPS crystals as black (B).
SPS: sodium polystyrene sulfonate; H&E: hematoxylin and eosin; AFB: acid-fast bacillus

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