Reporting on Adverse Clinical Events

Abstract

A 43-year-old female patient was hospitalized with chest pain and dysphagia after eating solids and liquids that developed approximately 1 day after starting oral clindamycin (300 mg), which had been prescribed as presurgical prophylaxis. No concurrent medications were noted in this report. Additional symptoms included a constant squeezing pain behind the breastbone, which spread to the upper stomach and back and was worsened by swallowing and movement. A physical examination revealed no other underlying medical issues. Laboratory screenings for cardiac and infectious etiologies were negative. An esophagogastroduodenoscopy revealed severe necrosis in the distal esophagus, with insufficient gastric cardia. Treatment included a spasmolytic and a proton pump inhibitor at full dose for 7 days and at half-dose for an additional 3 weeks. The use of clindamycin was also discontinued. At follow-up, 1 month later, a repeat esophagogastroduodenoscopy revealed no strictures, ulcers, erosions, and bleeding, but mild gastroesophageal reflux disease was present. Within 3 weeks of proton pump inhibitor therapy, there was complete resolution. It was recommended to continue on a proton pump inhibitor and to avoid clindamycin. The authors concluded that this patient developed necrotizing esophagitis related to clindamycin based on the temporal relationship between the administration of the drug and the appearance and resolution of symptoms. They noted that necrotizing esophagitis has been reported with the use of nonsteroidal anti-inflammatory agents but that this was the first case report noted with clindamycin. According to the Naranjo causality scale, this reaction was classified as probable. Clindamycin [Clindamycin] Benić MS (MS Benić, Department of Clinical Pharmacology and Toxicology, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka 51000, Croatia; e-mail: mirji.stanic@gmail.com) Clindamycin-induced necrotising oesophagitis. Postgrad Med J 92:741 (Nov) 2016