Olmesartan medoxomil
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Olmesartan medoxomil Sprue-like enteropathy, liver injury and malabsorptive syndrome: case report
A 59‐year‐old man developed sprue-like enteropathy leading to liver injury and malabsorptive syndrome during treatment with olmesartan medoxomil for hypertension. The man, who had hypertension, was receiving olmesartan medoxomil [olmesartan; dosage and route not stated] for 3 years. He presented with a 6-month history of severe abdominal cramping, excessive gas, fatigue, periodic diarrhoea, weight loss of 50 lbs and increasing transaminase enzyme levels. At the onset of his symptoms, liver enzymes were mildly elevated. A duodenal biopsy showed subtotal villous blunting with increased intraepithelial lymphocytes. There was no serologic evidence of coeliac disease. Seven months following onset of the symptoms ALT and AST peaked at 324 U/L and 162 U/L, respectively. Viral hepatitis panel was negative. Further liver injury workup revealed: positive antinuclear antibody 1:320 homogenous pattern, negative smooth muscle antibody/liver kidney microsomal antibody and serum IgG 1227 mg/dL. A liver biopsy revealed portal inflammation with scattered eosinophils, and scattered aggregates of foamy macrophages in the lobules. He was suspected with liver injury in the setting of a malabsorptive syndrome, secondary to olmesartan‐associated sprue‐like enteropathy. The man’s olmesartan medoxomil therapy was withdrawn. Within 3 weeks, the presenting symptoms resolved. Furthermore, transaminase enzymes normalised within 2 months after cessation of olmesartan medoxomil. Kogachi S, et al. Liver injury related to olmesartan-associated sprue-like enteropathy. Liver International 39: 2204, No. 11, Nov 2019. Available from: URL: http:// doi.org/10.1111/liv.14215
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