SHM Converge Scientific Abstract ePoster Gallery-Oh My Sartan! An Unexpected Cause of Enteropathy

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This case describes olmesartan enteropathy (OE), a rare sprue-like condition causing chronic diarrhea and weight loss months to years after starting olmesartan, an angiotensin receptor blocker. A 75-year-old woman with hypertension and chronic kidney disease presented with 9 months of worsening non-bloody diarrhea, refractory to antidiarrheals, and 40 pounds of weight loss. Initial outpatient evaluation was unrevealing: CBC and TSH were normal, infectious stool studies were negative, and celiac serologies were negative. Earlier upper endoscopy showed lymphocytic infiltrates, and she was treated empirically for possible small intestinal bacterial overgrowth without improvement.<br /><br />On admission, she had hypotension, acute kidney injury, hyperkalemia, and metabolic acidosis likely from volume depletion. Further workup excluded common mimics of sprue-like enteropathy, including celiac disease, infection, pancreatic insufficiency, and other inflammatory causes. CT imaging also showed diverticulitis, which was treated, but her diarrhea persisted. Repeat endoscopy demonstrated duodenal mucosal abnormalities, and biopsies revealed severe villous blunting and intraepithelial lymphocytosis, findings compatible with OE. Olmesartan was held during hospitalization, and her diarrhea improved. At follow-up two months later, symptoms had completely resolved.<br /><br />The case highlights key teaching points: OE should be considered in patients with chronic diarrhea, weight loss, and villous atrophy when celiac testing is negative; diagnosis is one of exclusion; and histology may show villous blunting with lymphocytic inflammation. Symptoms and histologic changes typically resolve after stopping olmesartan.

Asset Subtitle

Nelly Bellamy

Meta Tag

Author List Abigail Schulz, Ambika Viswanathan, Anna Kim, Christina Kahl, Danicela Younce, Dimitri Trembath, Jess Hatfield, Mahalya Gogerly-Moragoda, Nelly Bellamy

Category Clinical Vignettes

Concept Sprue-like Enteropathy

Concept Chronic Non-bloody Diarrhea

Concept Weight Loss

Concept Villous Blunting

Concept Drug Discontinuation

Distinguished Non-Finalist

Presenter Organization University of North Carolina at Chapel Hill

Presenting Author Nelly Bellamy

Track Adult

Keywords

olmesartan enteropathy

chronic diarrhea

weight loss

villous atrophy

sprue-like enteropathy

celiac-negative

intraepithelial lymphocytosis

duodenal biopsy

angiotensin receptor blocker

olmesartan discontinuation

Sprue-like Enteropathy

Chronic Non-bloody Diarrhea

Weight Loss

Villous Blunting

Drug Discontinuation