SHM Converge Scientific Abstract ePoster Gallery-Losartan-Associated Sprue-Like Enteropathy: Anemia Without Gastrointestinal Symptoms

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This case describes a 56-year-old man who developed symptomatic iron deficiency anemia shortly after starting losartan for hypertension. He presented with dizziness, lightheadedness, and malaise, but notably had no gastrointestinal symptoms such as abdominal pain, diarrhea, melena, hematochezia, or bowel habit changes. Initial evaluation showed normocytic anemia with low iron and ferritin levels.<br /><br />Because the cause of the anemia was unclear, the patient underwent extensive GI workup, including EGD, colonoscopy, and capsule endoscopy, all of which were visually unremarkable. However, duodenal biopsies later revealed villous blunting, inflammation, and increased intraepithelial lymphocytes, findings consistent with sprue-like enteropathy. Celiac disease was ruled out with a negative tissue transglutaminase IgA test.<br /><br />After losartan was discontinued, the patient’s symptoms improved quickly. His anemia and iron deficiency resolved completely and remained corrected even after stopping oral iron, supporting losartan as the cause.<br /><br />The key message is that ARBs can cause sprue-like enteropathy as a class effect, usually with gastrointestinal symptoms and villous atrophy, but this case was unusual because anemia was the only presenting feature and there was no visible mucosal inflammation on endoscopy. Losartan is especially relevant because it has been linked to anemia in this setting. Clinicians should consider ARB-associated enteropathy in patients who develop unexplained iron deficiency anemia after starting these medications, while also ruling out malignancy and celiac disease.

Asset Subtitle

Jessica Sosio

Meta Tag

Author List Jessica Sosio, Karla Geisse, Muhammad Chaudhary, Oluwagbenga Serrano

Category Clinical Vignettes

Concept Sprue-like Enteropathy

Concept Angiotensin Receptor Blocker

Concept Iron Deficiency Anemia

Concept Losartan

Concept Celiac Disease Testing

Distinguished Non-Finalist

Presenter Organization Indiana University

Presenting Author Jessica Sosio

Track Adult

Keywords

losartan

iron deficiency anemia

sprue-like enteropathy

angiotensin receptor blocker

villous blunting

duodenal biopsy

celiac disease negative

gastrointestinal workup

anemia resolution

drug-induced enteropathy

Sprue-like Enteropathy

Angiotensin Receptor Blocker

Iron Deficiency Anemia

Losartan

Celiac Disease Testing