Olmesartan-Induced Spruelike Enteropathy: An Emerging Cause of Small Bowel Injury.

Adnan Malik,Muhammad Imran Malik,Muhammad F Azrak,Muhammad Afzal,Faisal Inayat

doi:10.7759/cureus.9347

Abstract

Olmesartan-induced spruelike enteropathy is a rare clinical entity that is characterized by unexplained chronic diarrhea and weight loss. Prompt recognition of this adverse event may be challenging due to clinical and histologic similarities with other small intestinal pathologies. We hereby delineate the case of an elderly female with a 14-month clinical history of non-bloody diarrhea and weight loss. After extensive diagnostic workup and exclusion of probable etiologies, the patient was diagnosed with olmesartan-associated enteropathy. A dramatic clinical and histologic recuperation was achieved after discontinuation of olmesartan. This paper illustrates the overarching need for a detailed clinical history focusing on medication review in patients presenting with chronic diarrhea with no obvious cause. The spruelike enteropathy associated with olmesartan is an emerging cause of small bowel injury. Clinicians should maintain a high index of suspicion for this adverse drug reaction. Early and correct diagnosis carries paramount importance in sparing these patients from unnecessary diagnostic investigations and therapeutic delays.

Highlights

Rubio-Tapia et al first described olmesartan-associated enteropathy in 2012 [1]
Olmesartan-induced spruelike enteropathy is a rare clinical entity that is characterized by unexplained chronic diarrhea and weight loss
We hereby delineate the case of an elderly female with a 14-month clinical history of non-bloody diarrhea and weight loss

Summary

Introduction

Rubio-Tapia et al first described olmesartan-associated enteropathy in 2012 [1]. Since several case reports and small case series have been documented. The symptoms of chronic diarrhea and weight loss are disabling These presentation patterns frequently prompt clinicians to conduct extensive diagnostic workup [4]. The patient’s medical history was significant for hypertension, hyperlipidemia, osteoarthritis, chronic obstructive pulmonary disease, hypothyroidism, and diabetes mellitus At presentation, she had been adhering to antihypertensive therapy with olmesartan medoxomil (Benicar; Daiichi Sankyo, Inc., Basking Ridge, New Jersey) 40 mg/day over the past several years. She had been adhering to antihypertensive therapy with olmesartan medoxomil (Benicar; Daiichi Sankyo, Inc., Basking Ridge, New Jersey) 40 mg/day over the past several years Her other home medications included albuterol, budesonide, fluticasone, levothyroxine, insulin glargine, potassium fiber capsules, and vitamin B12. The patient has been symptom-free and continues to do well to date

Discussion

Conclusions

Disclosures

FDA Drug Safety Communication

Freeman HJ