Dasatinib-induced hemorrhagic colitis complicated with cytomegalovirus infection

  • Aya Nakaya | nakaya1016@yahoo.co.jp First Department of Internal Medicine, Kansai Medical University, Osaka, Japan. http://orcid.org/0000-0001-8365-3987
  • Yoshiko Azuma First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Shinya Fujita First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Atsushi Satake First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Takahisa Nakanishi First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Yukie Tsubokura First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Akiko Konishi First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Masaaki Hotta First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Hideaki Yoshimura First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Kazuyoshi Ishii First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Tomoki Ito First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
  • Shosaku Nomura First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.

Abstract

A 69-year-old man with chronic-phase chronic myeloid leukemia was initially treated with 100 mg dasatinib once a day. Despite a major molecular response within 9 months, he developed hemorrhagic colitis 32 months after starting dasatinib. Colonoscopy identified multiple hemorrhagic ulcers in the transverse colon. The pathological findings indicated cytomegalovirus infection. Dasatinib was stopped and he was started on ganciclovir. Three months later, colonoscopy confirmed the disappearance of the hemorrhagic ulcers. Dasatinib is a second-generation tyrosine kinase inhibitor used to treat chronic myeloid leukemia. As a multi-kinase inhibitor that acts on SRC-family kinases, its broader off-target kinase-inhibitory activity may account for the adverse events of dasatinib. Although gastrointestinal bleeding is common in patients taking dasatinib, the combination of cytomegalovirus infection and hemorrhagic colitis in the absence of systemic immunodeficiency is rare. Based on this case of dasatinibinduced hemorrhagic colitis with cytomegalovirus infection, we describe a possible mechanism and effective treatment.

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Published
2017-12-22
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Section
Case Reports
Keywords:
Dasatinib, Hemorrhagic colitis, Cytomegalovirus, Chronic myeloid leukemia
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How to Cite
Nakaya, A., Azuma, Y., Fujita, S., Satake, A., Nakanishi, T., Tsubokura, Y., Konishi, A., Hotta, M., Yoshimura, H., Ishii, K., Ito, T., & Nomura, S. (2017). Dasatinib-induced hemorrhagic colitis complicated with cytomegalovirus infection. Hematology Reports, 9(4). https://doi.org/10.4081/hr.2017.7415