Abstract
Olmesartan (brand name Benicar) is an antihypertensive drug clinicians commonly use to treat high blood pressure. Olmesartan induced enteropathy (OSE) is a rare entity that authors first identified in 2012. The etiological basis of OSE remains unclear, although authors have suggested that this condition could be due to alternations in cell mediated immune responses induced by the drug. The objective of the case report is to describe a patient who presented with diarrhea and was eventually diagnosed with OSE. A female patient in her later 60s presented to an emergency room after two recent hospitalizations with profound diarrhea, generalized weakness and weight loss. She underwent a diagnostic workup including endoscopy and colonoscopy. The patient’s endoscopy with duodenal biopsy revealed villous atrophy with attenuated and blunted villi with intraepithelial CD3 positive T lymphocytes, suggestive of gluten-induced enteropathy. When the patient’s symptoms did not improve after the authors placed her on a gluten free diet for a few days, they further investigated her for secretory diarrhea, including Gastrin, Somatostatin and Vasoactive Intestinal Peptide lab values that they found to be within normal limits. Due to the patient’s lack of improvement with initial treatment, the authors suspected OSE and stopped her olmesartan and the patients’ symptoms gradually improved in three weeks.
Highlights
Olmesartan is an Angiotensin II receptor blocker (ARB) approved in 2002 for treatment of hypertension
It has been postulated that villous atrophy has been caused by AT2 receptors activated by Angiotensin II
We present a case of olmesartan-induced enteropathy (OSE) in which a patient presented with severe diarrhea, generalized weakness and weight loss
Summary
Olmesartan is an Angiotensin II receptor blocker (ARB) approved in 2002 for treatment of hypertension. A female in her later 60s with a history of hypertension on amlodipine and olmesartan presented to an emergency room with complaints of profound diarrhea and generalized weakness that had started a month ago along with a twentypound weight loss Her recent medical history was notable for two recent hospital admissions with similar complaints and an extensive workup for diarrhea, including an endoscopy and a colonoscopy, which were negative. After two days in the hospital, she had a repeat endoscopy with duodenal biopsy, which revealed villous atrophy with attenuated and blunted villi with intraepithelial CD3 positive T lymphocytes (Images 1 and 2), suggestive of gluten enteropathy She was placed on gluten free diet for four weeks without a significant improvement in her symptoms. The patients’ symptoms gradually improved within three weeks
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