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Sprue-like enteropathy: case report A 77-year-old man developed sprue-like enteropathy during treatment with olmesartan-medoxomil/hydrochlorothiazide for arterial hypertension. The man was admitted to the emergency department with nausea, anorexia, profuse non-bloody and watery diarrhoea (five times a day), weight loss of 7.5kg and vomiting from 3 weeks. His medical history was significant for dyslipidaemia and arterial hypertension. He had been receiving olmesartan-medoxomil/hydrochlorothiazide [olmesartan/hydrochlorothiazide] 20/5mg for more than a year for the arterial hypertension [route and frequency not stated], along with concomitant simvastatin. Upon admission, dehydration was noted, and unspecified blood tests revealed prerenal acute kidney injury. The man’s prerenal acute kidney injury was corrected with unspecified fluid administration. The therapy with olmesartanmedoxomil/hydrochlorothiazide was discontinued. Immunological studies were found to be negative. Endoscopic studies (colonoscopy and upper digestive endoscopy) showed diffuse erythematous gastric mucosa; random biopsies of the duodenal, colonic and gastric mucosa were performed. He subsequently showed a favourable evolution. He had no further episodes of voimiting, diarrhoea and there was a gradual increase in his appetite. He was hospitalised for a total of 5 days after clinical normalisation, wihout any relapse, and then he was discharged. The man was re-admitted after 10 days with the same clinical presentation. He reported that, he started experiencing these symptoms the day immediately following discharge. Diagnostic hypotheses related to toxic and/or environmental exposures were considered. It was also observed that olmesartan-medoxomil/hydrochlorothiazide was not prescribed at discharge, but he had started receiving it after discharge. Biopsy revealed duodenal mucosa with polymorphic inflammatory infiltrate and villous atrophy in the chorion. Based on these observations, olmesartan-medoxomil/hydrochlorothiazide-induced enteropathy was suspected. Subsequently, olmesartan-medoxomil/hydrochlorothiazide was stopped. The clinical signs completely resolved within 1 week of discontinuation of olmesartan-medoxomil/hydrochlorothiazide. Hence, a diagnosis of olmesartan-medoxomil/hydrochlorothiazideinduced sprue-like enteropathy was made [time to reaction onset not stated]. Six months after discontinuation of olmesartanmedoxomil/hydrochlorothiazide, second biopsy revealed normalisation of the structural architecture of the mucosa. Matos ARF, et al. Olmesartan-induced enteropathy: A case of recurrent diarrhoea. European Journal of Case Reports in Internal Medicine 7: No. 8, 15 May 2020. Available 803515723 from: URL: http://doi.org/10.12890/2020_001614

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Reactions 21 Nov 2020 No. 1831