title: Rare case of losartan-induced cough complicated by rectus sheath haematoma: in a patient on rivaroxaban therapy.
abstract: Spontaneous rectus sheath haematomas and cough secondary to losartan are individually rare conditions. Abdominal wall haematomas present with abdominal pain and abdominal mass. Most patients are managed conservatively; Surgery or embolisation is indicated for shock, infection, rupture into the peritoneum or intractable pain. This is a man aged 65 years presented with dry cough and right-sided abdominal pain. He started losartan a few weeks prior to the onset of cough and had been on rivaroxaban for prior deep venous thrombosis. The right side of his abdomen was distended, bruised and tender. His haemoglobin dropped from 13.3to 9.5 g/dL. CT abdomen/pelvis showed a large 14.5×9.1×4.5 cm haematoma within the right lateral rectus muscle. His only risk factor for developing rectus sheath haematoma was cough in the setting of anticoagulation. Dry cough due to angiotensin receptor blockers is rare, but can have very serious consequences.
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors.forename: Goutham
authors.initials: G
authors.lastname: Talari
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors.forename: Preetham
authors.initials: P
authors.lastname: Talari
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sweigart
authors.affiliation: Department of Internal Medicine-Nephrology, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors.forename: Sadiq
authors.initials: S
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D003371:Cough / Q000139:chemically induced*; D003937:Diagnosis, Differential; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D019808:Losartan / Q000009:adverse effects*; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging; D017568:Rectus Abdominis / Q000000981:diagnostic imaging; D000069552:Rivaroxaban / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents; D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban; D019808:Losartan