A Case of Crystal-Associated Colitis Caused by Sevelamer

Sevelamer, a calcium-free phosphate binder used in chronic kidney disease, can lead to gastrointestinal side effects and, rarely, crystal-associated colitis. We present a case of sevelamer-induced colitis in a 66-year-old man with end-stage renal disease. Colonoscopy revealed characteristic crystalloid resins and ulcers in the colon. Recognition of this condition is difficult, often mimicking ischemic colitis. Pathophysiologic mechanisms involve direct toxic effects and potential stercoral colitis as the result of dehydration. Treatment primarily involves discontinuation of sevelamer, but managing hyperphosphatemia remains a challenge. Further research is needed to understand crystal-associated colitis and optimize management in this complex patient population.