Severe spruelike enteropathy and collagenous colitis caused by olmesartan

Abstract

Background: Olmesartan, which is an angiotensin II receptor blocker, reportedly causes spruelike enteropathy, with intestinal villous atrophy as its typical histopathological finding. Interestingly, collagenous and/or lymphocytic gastritis and colitis occur in some patients. We report the case of a 73-year-old Japanese man with a 2-month clinical history of severe diarrhea and weight loss. There were few reports in which spruelike enteropathy and collagenous colitis were both observed and could be followed up.

Case presentation: We report a case of a 73-year-old man with a 2-month clinical history of severe diarrhea and weight loss. He had taken olmesartan for hypertension treatment for 5 years. Endoscopic examination with biopsies revealed intestinal villous atrophy and collagenous colitis. Suspecting enteropathy caused by olmesartan, which was discontinued on admission because of hypotension, we continued to stop the drug. Within 3 weeks after olmesartan discontinuation, his clinical symptoms improved. After 3 months, follow-up endoscopy showed improvement of villous atrophy but not of the thickened collagen band of the colon. However, the mucosa normalized after 6 months, histologically confirming that the preexistent pathology was finally resolved.

Conclusions: This report presents a case in which spruelike enteropathy and collagenous colitis were both observed and could be followed up. In unexplained cases of diarrhea, medication history should be reconfirmed and this disease should be considered a differential diagnosis.

Keywords: Case report; Collagenous colitis; Intestinal diseases; Spruelike enteropathy; Villous atrophy.

Fig. 1

Esophagogastroduodenoscopy at the initial visit. a White-light imaging shows villous atrophy and a mosaic pattern of the duodenal mucosa. b Magnification endoscopy with narrow-band imaging shows villous atrophy of the duodenal mucosa

Fig. 2

a Duodenal biopsy (hematoxylin–eosin, 0924; top: –743; width: 5205; height: 3719; visibility: visible; mso-wrap-style: square); b Duodenal biopsy (Masson trichrome, ichromeichrome eosin, 0924; top: Colonic biopsy (hematoxylin–eosin, 0924; top: − 743; width: 5205; height: 3719; visibility: visible)

Fig. 3

Esophagogastroduodenoscopy showed a normal appearance of the duodenum 3 months after olmesartan discontinuation

Fig. 4

Biopsy showed an almost complete recovery of the villi on the duodenal mucosa 3 months after olmesartan discontinuation (hematoxylin–eosin, redof)