E3 PreliminaryPreliminaryPEM unclearPeer-reviewedMachine draft
Severe eosinophilic colitis caused by neuropathic agents in a patient with chronic fatigue syndrome and functional abdominal pain: case report and review of the literature.
Fragkos, Konstantinos C, Barragry, John, Fernando, Charisma Shahi et al. · Zeitschrift fur Gastroenterologie · 2018 · DOI
Quick Summary
This case report describes one young woman with ME/CFS and chronic pain who developed severe inflammation in her colon (eosinophilic colitis) after taking two common pain medications—gabapentin and pregabalin. Her symptoms improved when she stopped the medications and received steroid treatment. This is an extremely rare side effect, but doctors should be aware of it if ME/CFS patients taking these drugs develop abdominal pain, diarrhea, and blood cell changes.
Why It Matters
Many ME/CFS patients use gabapentin or pregabalin for pain and neurological symptoms, making awareness of this rare but serious adverse effect clinically important. This case report expands the known safety profile of these commonly prescribed medications in the ME/CFS population and highlights the need for gastrointestinal symptom monitoring during neuropathic pain treatment.
Observed Findings
- Abdominal pain, diarrhea, and elevated serum eosinophils developed after gabapentin exposure, resolved upon discontinuation, and recurred with pregabalin exposure
- Magnetic resonance imaging revealed ascending colon involvement
- Colonoscopic biopsy showed dense eosinophilic infiltration with microabscesses, primarily in the ascending colon
- No other organ involvement was detected
- Symptoms improved with corticosteroid administration after drug discontinuation
Inferred Conclusions
- Gabapentin and pregabalin should be considered as potential causative agents in patients presenting with eosinophilic colitis
- Temporal correlation between neuropathic agent administration and gastrointestinal symptom onset warrants clinical suspicion and investigation
- Clinic suspicion of drug-induced eosinophilic colitis should be raised in any patient on these medications presenting with abdominal pain, diarrhea, and peripheral eosinophilia
Remaining Questions
- What is the underlying immunological or pharmacological mechanism by which gabapentin or pregabalin triggers eosinophilic colitis?
- Are certain patient populations (e.g., those with ME/CFS or specific genetic factors) at higher risk for this adverse reaction?
What This Study Does Not Prove
This single case report cannot establish causation or determine the incidence of eosinophilic colitis from these medications in the broader ME/CFS population. It does not explain the underlying mechanism of this adverse reaction or identify which patients are at highest risk. The temporal association observed does not prove gabapentin or pregabalin causes eosinophilic colitis in all or most patients.
Tags
Symptom:PainFatigue
Biomarker:Blood Biomarker
Method Flag:Weak Case DefinitionNo ControlsSmall Sample
Metadata
- DOI
- 10.1055/a-0596-7981
- PMID
- 29890559
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 8 April 2026
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