S3913 Recurrent Ischemic Colitis in the Setting of Lisinopril Use: A Case Report

Introduction: Ischemic colitis presents with acute-onset diarrhea, hematochezia, and abdominal pain. The incidence of recurrent disease is highly variable. Along with its variable rate, inciting factors also vary greatly. Literature has shown there is associated risk between ACE-inhibitors (ACE-I) and recurrent ischemic colitis. Our case is an example of how ACE-I may be the cause of recurrent ischemic colitis and highlights the importance of continued research on this matter. Case Description/Methods: Our patient is a 77-year-old woman with prior medical history of hypertension, obesity, ischemic colitis, and C. difficile who presented to the hospital with acute onset hematochezia and diarrhea associated with left-sided abdominal tenderness and lightheadedness. She has had 4 documented hospitalizations with the same clinical presentation over the past 5 years. The patient is asymptomatic between episodes. CTA imaging has persistently been unremarkable for active bleed. Prior colonoscopies were unremarkable and no biopsies were taken. Colonoscopy from this episode showed segmental erythema and ulceration of the sigmoid colon concerning for ischemic colitis. Biopsy revealed colonic mucosa with focal erosion, minimal acute inflammation and ischemic changes. It is likely that her prior symptoms were related to ischemic colitis given similar clinical presentation. Upon follow-up in the clinic, extensive chart review revealed her only risk factors are obesity, hypertension, and lisinopril use. Discussion: Recurrent ischemic colitis is rare and is often associated with several risk factors including hypertension, and in some cases, ACE-I use. Based off current literature, it appears that there may be a relationship between ACE-I use and recurrent ischemic colitis. There is limited evidence of ACE-I and their role in ischemic colitis. More research in the field is warranted as these are first-line anti-hypertensives and their use is often associated with other risk factors for ischemic colitis.