Olmesartan‐induced enteropathy associated with cutaneous lesions

Abstract

Key Clinical MessageOlmesartan is an angiotensin II receptor antagonist which may cause severe sprue‐like enteropathy with duodenal villous atrophy. Skin lesions may be associated as reported for the first time in our case. Clinicians should be informed of this side effect and its reversibility after suspension of the drug.

Severe Sprue-Like Enteropathy and Colitis due to Olmesartan: Lessons Learned From a Rare Entity

“…Additionally, a crucial factor to consider that has occurred in previous cases [ 1 , 6 , 7 , 10 , 11 , 13 - 15 ] but not particularly emphasized is how hospitalized patients frequently have their home olmesartan medication temporarily suspended prior to a formal diagnosis. Reasons for this include therapeutic interchange to an alternate ARB due to the institutional formulary, held for medical reasons such as hypotension or acute kidney injury, or held along with all other drugs for suspicion of a possible drug-induced phenomenon of unknown etiology.…”

“…If performed, biopsy typically shows histological improvement or remission in OAE relatively quickly, on the order of months [ 1 , 17 , 18 ]. Re-challenging patients with olmesartan is not recommended, though has occurred unknowingly in previous studies [ 7 , 10 , 11 , 14 ] with resumption of symptoms exhibited. It is not unreasonable at this point in time to consider replacing a patient’s olmesartan to an alternative ARB.…”

Olmesartan‐associated duodenal villous atrophy, an emerging clinical issue

“…The patients raised the question with their treating doctors as to whether the symptoms could be attributed to antihypertensive medication. There have subsequently been several published case series and case reports of olmesartan‐associated duodenal villous atrophy describing over 100 patients with this condition. The most striking feature of presentation is the presence of severe watery diarrhoea, usually occurring in association with weight loss .…”

Significant Weight Loss in a Patient Taking Olmesartan: An Unusual Case Report

“…Other unusual cases of this entity include colonic perforation [24], Wernicke-Korsakoff syndrome due to vitamin B1 malabsorption with minimal gastrointestinal symptoms [25], nonalcoholic steatohepatitis [26] and simultaneous olmesartan-associated uveitis with enteropathy [27]. Furthermore, a case with severe diarrhea, weight loss and a cutaneous lesion histologically indicative of pemphigoid or acquired bullous epidermolysis-like lesions has been reported [28]. Both the aforementioned unusual manifestations of olmesartan-induced enteropathy, as well as our case highlight the clinical diversity of this syndrome.…”

“…Angiotensin II promotes enterocyte apoptosis, suggesting that olmesartan-associated enteropathy results from excess apoptosis of enterocytes. The high affinity of olmesartan for AT1 receptors may explain the greater incidence of enteropathy with this ARB [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”