Olmesartan-Induced Enteropathy: A Case of Recurrent Diarrhoe
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Olmesartan-induced enteropathy (OIE) is a new clinical entity, characterized by diarrhoea and weight loss, which should be included in the differential diagnosis of seronegative villous atrophy with negative coeliac serology. Although the frequency of this disease seems to be low, it is very important to rapidly identify it as complications may be severe, and discontinuation of the causative drug leads to the resolution of symptoms and mucosal healing.

A 77-year-old man with arterial hypertension and dyslipidaemia, treated with olmesartan/hydrochlorothiazide and simvastatin, was admitted with a 3-week history of anorexia, nausea, vomiting, profuse diarrhoea and weight loss. He was dehydrated and blood tests showed acute kidney injury. The aetiological study was inconclusive. The patient had a favourable clinical evolution during hospitalization and was discharged. However, after about 10 days at home, he was re-admitted to hospital with the same clinical presentation. It was noticed that olmesartan had not been prescribed during the previous admission but had been restarted on an outpatient basis. Biopsy examination showed duodenal mucosa with villous atrophy and polymorphic inflammatory infiltrate. Antibody testing for coeliac disease was negative. Based on these facts, it was hypothesized that the patient had olmesartan-induced enteropathy, which was subsequently confirmed.

Learning Points:
1. Drug-induced sprue-like enteropathy must be considered in the differential diagnosis of patients with diarrhoea, weight loss, and villous atrophy of the duodenal mucosa of unknow origin.
2. Olmesartan has been associated with the development of enteropathy.
3. Olmesartan-induced enteropathy can happen years after drug initiation.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1614/2122
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