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Case Reports
. 2025 Feb 23;17(2):e79534.
doi: 10.7759/cureus.79534. eCollection 2025 Feb.

Life-Threatening Haemorrhagic Enterocolitis: A Rare Complication of Chemotherapy With Cyclophosphamide

Gousmahammad Myageri  1 , Ajith Kumar Ak  1 , Abhijith Bale  2 , Yathish Gc  3 , Venkatesha Gupta Kv  1
Affiliations
Case Reports

Life-Threatening Haemorrhagic Enterocolitis: A Rare Complication of Chemotherapy With Cyclophosphamide

Gousmahammad Myageri et al. Cureus. .

Abstract

Cyclophosphamide (CPA) is a commonly used alkylating agent with its use extending from chemotherapy to immunosuppression. Herein, we present a case of a 61-year-old lady diagnosed with Sjögren's syndrome one year ago, who recently started on CPA therapy and presented to ICU with the sudden onset of bloody diarrhoea and shock, requiring fluid resuscitation and vasopressor support. An extensive evaluation, including stool routine analysis, cultures, stool BioFire® FilmArray® (gastrointestinal panel) (BioFire Diagnostics, LLC, Salt Lake City, USA), contrast-enhanced CT (CECT) of the abdomen, colonoscopy, and biopsy, ruled out infectious, inflammatory, ischemic, and malignant causes. After discontinuation of CPA and supportive therapy, her clinical condition improved, and she was discharged. Haemorrhagic cystitis, myelosuppression, gonadal toxicity and interstitial pneumonia are well-known side effects of CPA. Haemorrhagic enterocolitis is a rare adverse effect of CPA therapy. Through this case report, we aim to highlight that haemorrhagic enterocolitis can be a potentially life-threatening adverse effect of CPA, a drug widely used in rheumatological and oncological conditions. Increased awareness among treating physicians can help in early suspicion and appropriate management, including prompt discontinuation of the drug and consideration of alternative treatment options.

Keywords: complication of treatment; cyclophosphamide therapy; haemorrhagic enterocolitis; life threatening; sjögren's syndrome.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication 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. Thickened Jejunal Loops
(1) Ascending colon; (2) Jejunal loops; (3) Descending colon
Figure 2
Figure 2. Thickened Ascending and Descending Colon With Mucosal Enhancement
(1) Ascending colon; (2) Bowel loops showing mucosal enhancement; (3) Descending colon
Figure 3
Figure 3. Coronal Section of the Abdomen Showing Bowel Wall Thickening
(1) Thickened ascending colon; (2) Thickened jejunal loops; (3) Thickened descending colon; (4) Thickened ileal loops
Figure 4
Figure 4. Colonoscopy Showing Mucosal Edema and Haemorrhage
Figure 5
Figure 5. Colonoscopic Image Showing Multiple Erosions With Few Adherent Clots
See this image and copyright information in PMC

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