ArticleCase reports in gastroenterology
Case Report: Olmesartan-Induced Enteropathy Mimicking Amyloidosis in the Setting of New Multiple Myeloma Diagnosis.
Article in Case reports in gastroenterology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Olmesartan-induced enteropathy is an uncommon but important cause of severe chronic diarrhea and weight loss that can mimic celiac disease and infiltrative gastrointestinal disorders. Case Presentation: We report a 71-year-old man on long-term olmesartan who presented with months of diarrhea, nausea/vomiting, profound weakness, and ∼100 pounds of unintentional weight loss. Esophagogastroduodenoscopy demonstrated duodenal villous blunting with lamina propria lymphoplasmacytic inflammation and rare periodic acid-Schiff-positive macrophages. An empiric 3-week gluten-free diet trial was ineffective. Celiac serologies, infectious stool studies, and HIV testing were negative. Laboratory evaluation revealed anemia, elevated creatinine, hypercalcemia, and a gamma gap; serum and urine protein electrophoresis showed an M-protein, and bone marrow biopsy confirmed multiple myeloma. Repeat duodenal biopsies again showed villous blunting, while Congo red staining was negative, arguing against gastrointestinal amyloidosis. Olmesartan-induced enteropathy was favored; olmesartan was discontinued and budesonide was started. Within 1 month, gastrointestinal symptoms resolved and the patient gained 20 pounds. Conclusion: Recognition of this drug effect is critical, particularly when concurrent hematologic disease raises concern for infiltrative etiologies.
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