title: Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug.
abstract: Collagenous sprue (CS) is a pattern of small-bowel injury characterized histologically by marked villous blunting, intraepithelial lymphocytes, and thickened sub-epithelial collagen table. Clinically, patients present with diarrhea, abdominal pain, malabsorption, and weight loss. Gluten intolerance is the most common cause of villous blunting in the duodenum; however, in a recent case series by the Mayo Clinic, it has been reported that olmesartan can have a similar effect. In this case report, a 62-year-old female with a history of hypothyroidism and hypertension managed for several years with olmesartan presented with abdominal pain, weight loss, and nausea. Despite compliance to a gluten-free diet, the patient's symptoms worsened, losing 20 pounds in 3 wk. Endoscopy showed thickening, scalloping, and mosaiform changes of the duodenal mucosa. The biopsy showed CS characterized by complete villous atrophy, lymphocytosis, and thickened sub-epithelial collagen table. After 2 mo cessation of olmesartan, the patient's symptoms improved, and follow-up endoscopy was normal with complete villous regeneration. These findings suggest that olmesartan was a contributing factor in the etiology of this patient's CS. Clinicians should be aware of the possibility of drug-induced CS and potential reversibility after discontinuation of medication.
authors.affiliation: Jennifer A Nielsen, Division of Research, ProPath Laboratory, Dallas, TX 75247, United States.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Nielsen
authors.forename: Anita
authors.initials: A
authors.lastname: Steephen
authors.forename: Matthew
authors.initials: M
authors.lastname: Lewin
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001284:Atrophy; D001706:Biopsy; D064068:Collagenous Sprue / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D004384:Duodenoscopy; D004386:Duodenum / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D008875:Middle Aged; D012038:Regeneration; D012307:Risk Factors; D013777:Tetrazoles / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan
keywords: Celiac disease; Collagenous sprue; Duodenum; Olmesartan; Patient-drug interaction