Fluoroquinolone Induced Ischemic Colitis: A Case Series and Review of Literature

Ischemic colitis (IC) occurs when blood flow to the colon is compromised, typically appearing at the splenic flexure or rectosigmoid junction, known as ‘watershed’ areas. Various pharmacological agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, phentermine, antipsychotics, and certain antibiotics (notably penicillin derivatives) have been implicated in IC pathogenesis. Although fluoroquinolones have been associated with pseudomembranous colitis in Clostridioides difficile infection (CDI), culture-negative colitis following fluoroquinolones is extremely rare. We report two cases of ciprofloxacin-induced IC. The first case was that of a 38-year-old woman who developed symptoms on day 4 of ciprofloxacin use. The second case involved a 68-year-old woman who developed symptoms one week after completing a 10-day course of ciprofloxacin. Colonoscopy and histopathology confirmed the presence of IC in both cases.