Paper
A Case of Severe Sprue-like Enteropathy Associated With Losartan.
Published Oct 1, 2015 · A. Negro, G. M. Rossi, R. Santi
Journal of clinical gastroenterology
23
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Abstract
To the Editor: Sprue-like enteropathy associated with the use of olmesartan, an angiotensin II receptor blocker (ARB), has been described in 2 case series.1,2 Whether this association is limited to olmesartan or concerns the whole ARBs class is an unresolved issue. Single cases associated with other ARBs (irbesartan and valsartan) have been reported.2,3 We report a case of sprue-like enteropathy associated with losartan. To our knowledge, this is the first case involving losartan reported to date. A 67-year-old man presented to our hospital for chronic diarrhea and an 11kg weight loss over the preceding 9 months. He reported 4 to 5 daily evacuations of nonbloody diarrhea and denied loss of appetite or changes in his usual gluten-containing diet. In the last 3 years, he had been taking losartan 50mg/d. Physical examination showed mild abdominal tenderness. Laboratory tests revealed anemia and reduced plasma levels of iron, albumin (2.9 g/dL), K, calcium, phosphorus, total cholesterol, HDL-cholesterol, and triglycerides. Fecal occult blood tests were repeatedly negative, as well as microbiologic tests for bacteria, parasites, and viruses potentially responsible of diarrhea. Antitissue transglutaminase IgA antibodies were absent in the presence of normal IgA levels. HLA-DQ typing was negative for celiac disease permissive haplotypes (HLA DQ2/8). The patient underwent an esophagogastroduodenoscopy. Histology of duodenal biopsies showed total villous atrophy and inflammation of the lamina propria. We discontinued losartan administration. In a few days, stool evacuations decreased without any other interventions. He was then discharged with definitive suspension of losartan. The patient achieved complete resolution of diarrhea within 1 week and in the next 8 months he regained 11kg weight, despite maintenance of a gluten-containing diet. Follow-up laboratory investigations showed resolution of anemia and normalization of the other deficiencies reported. Two follow-up esophagogastroduodenoscopies were performed at 3 and 11 months after drug withdrawal: histology of duodenal biopsies showed partial and complete reconstruction of villous architecture, respectively. Our case further suggests that this rare but severe adverse effect might be a class effect rather than that of a specific ARB.
Losartan may be associated with severe sprue-like enteropathy, suggesting it may be a class effect rather than a specific angiotensin II receptor blocker.
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