SHM Converge Scientific Abstract ePoster Gallery-Olmesartan-Induced Enteropathy in an Elderly Patient With Refractory Diarrhea and Weight Loss

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An 83-year-old woman with GERD, dysphagia, and pancreatic insufficiency was admitted after four months of severe watery diarrhea, profound weight loss of 40 pounds, and reduced oral intake. Her symptoms had repeatedly led to outside-hospital visits for presumed viral illness, with only fluid and electrolyte replacement.<br /><br />Initial evaluation showed elevated CRP and TSH, but normal WBC, ESR, lipase, fecal elastase, and tissue transglutaminase IgA antibodies. Physical exam revealed dry mucous membranes and bilateral leg edema. CT abdomen/pelvis found a cystic lesion in the uncinate process, later confirmed by MRCP as an IPMN. EGD showed scalloped duodenal mucosa concerning for celiac disease, along with duodenitis, gastritis, and a small hiatal hernia. Colonoscopy was unremarkable.<br /><br />Because of strong concern for celiac disease, she was started on a gluten-free diet, but symptoms did not improve. Duodenal biopsy instead showed findings consistent with medication-induced enteropathy, and the absence of villous atrophy argued against celiac disease. The case was ultimately diagnosed as olmesartan-induced enteropathy (OIE), a rare but important cause of chronic diarrhea and malnutrition in older adults that can mimic celiac disease histologically and clinically.<br /><br />She improved rapidly after IV methylprednisolone and was discharged on an extended budesonide course. A PICC line was placed for total parenteral nutrition. Follow-up EGD four months later showed resolution of mucosal changes.<br /><br />This case highlights the need to consider OIE in elderly patients with refractory diarrhea and weight loss, especially when celiac testing is negative and symptoms fail to respond to dietary therapy.

Asset Subtitle

Carlin L. Lockwood

Meta Tag

Author List Alexandra Diaz-Barbe, Anna Symmes, Carlin L. Lockwood

Category Clinical Vignettes

Concept Olmesartan-Induced Enteropathy

Concept Chronic Diarrhea

Concept Offending Drug

Concept Weight Loss

Concept Malnutrition

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Carlin L. Lockwood

Track Adult

Keywords

olmesartan-induced enteropathy

chronic diarrhea

weight loss

celiac disease mimic

elderly patient

duodenal biopsy

malnutrition

gluten-free diet failure

budesonide treatment

total parenteral nutrition

Olmesartan-Induced Enteropathy

Chronic Diarrhea

Offending Drug

Weight Loss

Malnutrition