Ischemic Colitis Induced by Concurrent Non-steroidal Anti-inflammatory Drug (NSAID) and Corticosteroid Use for Back Pain.

Ischemic colitis is a multifactorial condition typically seen in older adults with risk factors for vascular disease and hypoperfusion, but it can also occur in healthier individuals due to medication-induced mucosal injury. We discuss a case of a 55-year-old male who developed right-sided ischemic colitis following two weeks of high-dose nonsteroidal anti-inflammatory drug (NSAID) use, combined with systemic corticosteroids for back pain. He presented with severe abdominal pain and bright red rectal bleeding, with labs suggestive of inflammation, initially raising the concern for gastritis and infectious colitis. Imaging showed nonspecific, acute mucosal inflammation, but endoscopic evaluation with biopsies confirmed the diagnosis of ischemic colitis, rather than infectious colitis. Conservative management with bowel rest, IV fluids, pain medications, and antibiotics led to a full recovery, with complete healing of mucosal ischemia on follow-up colonoscopy. This case demonstrates the potential for drug-induced ischemic colitis in patients without classic causes and focuses on the importance of careful medication review in patients presenting with acute colitis.