SHM Converge Scientific Abstract ePoster Gallery-A Seemingly Arbitrary Cause of Diarrhea

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This case describes a 74-year-old woman with hypertension treated with olmesartan who developed acute worsening of chronic watery diarrhea severe enough to cause failure to thrive and hospitalization. The report highlights chronic diarrhea as a common but often underrecognized problem that can lead to dehydration, electrolyte loss, and organ damage.<br /><br />The key teaching point is ARB-induced enteropathy, a sprue-like illness first described in 2012. It can closely resemble celiac disease, but typical clues include negative celiac serologies and lack of improvement on a gluten-free diet. Although olmesartan is the most commonly implicated angiotensin receptor blocker, other ARBs have also rarely been associated with this condition.<br /><br />Symptoms may begin months to years after starting the medication, suggesting a delayed immune-mediated process. Proposed mechanisms include cell-mediated injury, with some reports showing increased CD8+ lymphocytes in the intestinal mucosa. Endoscopic appearance is often nonspecific, so biopsy and pathology are important for diagnosis. Common histologic findings include villous atrophy, intraepithelial lymphocytosis, and crypt hyperplasia, though no single pathologic feature is diagnostic on its own.<br /><br />The main treatment is stopping the offending ARB, which can lead to complete clinical and histologic recovery over weeks to months. Corticosteroids may be used temporarily for symptom relief after the drug is discontinued. This case emphasizes the importance of considering medication-induced causes in patients with unexplained chronic diarrhea, especially when they are taking olmesartan.

Asset Subtitle

Celyn Bregio

Meta Tag

Author List Azka Afzal, Celyn Bregio

Category Clinical Vignettes

Concept Chronic Diarrhea

Concept Enteropathy

Concept Olmesartan

Concept Angiotensin Receptor Blocker

Concept Drug Discontinuation

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Celyn Bregio

Track Adult

Keywords

olmesartan

chronic diarrhea

ARB-induced enteropathy

sprue-like illness

celiac disease mimic

villous atrophy

intraepithelial lymphocytosis

crypt hyperplasia

medication-induced diarrhea

failure to thrive

Chronic Diarrhea

Enteropathy

Olmesartan

Angiotensin Receptor Blocker

Drug Discontinuation