Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea
A 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associa...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Case Reports in Gastrointestinal Medicine |
| Online Access: | http://dx.doi.org/10.1155/2013/618071 |
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| author | Stephanie E. Dreifuss Yutaka Tomizawa Nicholas J. Farber Jon M. Davison Adam E. Sohnen |
| author_facet | Stephanie E. Dreifuss Yutaka Tomizawa Nicholas J. Farber Jon M. Davison Adam E. Sohnen |
| author_sort | Stephanie E. Dreifuss |
| collection | DOAJ |
| description | A 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associated with prerenal azotemia for which olmesartan (40 mg/day) was held. Initial workup for chronic diarrhea was essentially unremarkable. Then, EGD was performed with small bowel biopsy, which showed a moderate villous blunting and an intraepithelial lymphocyte infiltration. Celiac disease was excluded by negative conventional serology tests and the absence of clinical response to a gluten-free diet. In the interim, diarrhea became resolving without any other interventions, and clinical response was achieved even with gluten-containing diet. Two months later, he achieved a complete resolution of diarrhea and regained 20-pound weight. Spruelike enteropathy is a clinical entity manifested by chronic diarrhea and intestinal villous atrophy. Spruelike enteropathy associated with olmesartan as a cause of drug-induced diarrhea is rare, and it has been reported only in a case series to date. This case highlighted the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of spruelike enteropathy. |
| format | Article |
| id | doaj-art-8d2e444fedc04894bf96fcd3e0e184e2 |
| institution | OA Journals |
| issn | 2090-6528 2090-6536 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Gastrointestinal Medicine |
| spelling | doaj-art-8d2e444fedc04894bf96fcd3e0e184e22025-08-20T02:09:34ZengWileyCase Reports in Gastrointestinal Medicine2090-65282090-65362013-01-01201310.1155/2013/618071618071Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe DiarrheaStephanie E. Dreifuss0Yutaka Tomizawa1Nicholas J. Farber2Jon M. Davison3Adam E. Sohnen4University of Pittsburgh, Graduate School of Medicine, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USAUniversity of Pittsburgh Medical Center, Department of Internal Medicine, 5230 Centre Avenue, Pittsburgh, PA 15232, USAUniversity of Pittsburgh, Graduate School of Medicine, 401 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USAUniversity of Pittsburgh Medical Center, Department of Pathology, 300 Halket Street, Pittsburgh, PA 15213, USAUniversity of Pittsburgh Medical Center, Department of Internal Medicine, 5230 Centre Avenue, Pittsburgh, PA 15232, USAA 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associated with prerenal azotemia for which olmesartan (40 mg/day) was held. Initial workup for chronic diarrhea was essentially unremarkable. Then, EGD was performed with small bowel biopsy, which showed a moderate villous blunting and an intraepithelial lymphocyte infiltration. Celiac disease was excluded by negative conventional serology tests and the absence of clinical response to a gluten-free diet. In the interim, diarrhea became resolving without any other interventions, and clinical response was achieved even with gluten-containing diet. Two months later, he achieved a complete resolution of diarrhea and regained 20-pound weight. Spruelike enteropathy is a clinical entity manifested by chronic diarrhea and intestinal villous atrophy. Spruelike enteropathy associated with olmesartan as a cause of drug-induced diarrhea is rare, and it has been reported only in a case series to date. This case highlighted the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of spruelike enteropathy.http://dx.doi.org/10.1155/2013/618071 |
| spellingShingle | Stephanie E. Dreifuss Yutaka Tomizawa Nicholas J. Farber Jon M. Davison Adam E. Sohnen Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea Case Reports in Gastrointestinal Medicine |
| title | Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea |
| title_full | Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea |
| title_fullStr | Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea |
| title_full_unstemmed | Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea |
| title_short | Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea |
| title_sort | spruelike enteropathy associated with olmesartan an unusual case of severe diarrhea |
| url | http://dx.doi.org/10.1155/2013/618071 |
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