Case Report
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World J Gastroenterol. Oct 28, 2013; 19(40): 6928-6930
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6928
Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug
Jennifer A Nielsen, Anita Steephen, Matthew Lewin
Jennifer A Nielsen, Division of Research, ProPath Laboratory, Dallas, TX 75247, United States
Anita Steephen, Texas Digestive Disease Consultants, Southlake, TX 76092, United States
Matthew Lewin, Division of Gastrointestinal Pathology, ProPath Laboratory, Dallas, TX 75247, United States
Author contributions: Nielsen JA, Steephen A and Lewin M contributed to the conception, design and acquisition of data, and approved the final version to be published; Steephen A analyzed and interpreted the endoscopy; Lewin M analyzed and interpreted the gastrointestinal pathology; Nielsen JA and Lewin M drafted the article and revised it critically for important intellectual content.
Correspondence to: Matthew Lewin, MD, Division of Gastrointestinal Pathology, ProPath Laboratory, 1355 River Bend Dr., Dallas, TX 75247, United States. matthew.lewin@propath.com
Telephone: +1-214-2371628 Fax: +1-214-2371743
Received: June 6, 2013
Revised: July 31, 2013
Accepted: August 17, 2013
Published online: October 28, 2013
Processing time: 160 Days and 6.7 Hours
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.

Keywords: Collagenous sprue; Celiac disease; Olmesartan; Patient-drug interaction; Duodenum

Core tip: 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, which raises suspicion of celiac disease. Clinicians should be aware of the possibility of drug-induced CS and potential reversibility after discontinuation of medication.