Authors P. HENRY (1), H. DANO (2), H. PIESSEVAUX (3), A. JOURET-MOURIN (2) / [1] Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium, Anatomie pathologique, [2] Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium, Pathology, [3] Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium, Gastroenterology Introduction Sprue-like enteropathy associated with olemesartan was first described in 2012. Almost all reported cases presented with severe diarrhoea and weight loss. Variable degrees of duodenal villous atrophy were present in the majority of the patients, which may mimic celiac disease. Aim We report on a 63-year-old male patient referred to the gastroenterology department for severe diarrhoea, with significant dehydration and management in the intensive care unit. This patient had a history of type 2 diabetes, hypertension and diverticulitis. Systematic anamnesis revealed a daily consumption of more than a bottle of wine and ~30 cigarettes. His usual medication consisted of pantroprazole, fluoxetine, moxonidine, amlodipine, nebivolol and olmesartan. Methods The management of the patient included a GI endoscopy, with biopsies at different levels of the GI tract. Results Histology revealed an excess of intraepithelial lymphocytes in both the gastric and colonic regions, as well as celiac-like abnormalities in the duodenum (i.e.villous atrophy, intraepithelial lymphocytes and lamina propria inflammation). The diagnosis of olmesartan-associated enteropathy was considered. The clinical signs and histological alterations completely resolved after drug withdrawal. Conclusions In the literature, most patients with olmesartan-induced enteropathy present with sprue-like manifestations. Few patients have both gastritis and lymphocytic colitis. Here, we report on a patient with a panlymphocytic digestive disease (lymphocytic gastritis, colitis and duodenitis) inducing enteropathy caused by olmesartan. Olmesartan-induced enteropathy is a new clinical entity that must be included in the differential diagnosis of not only sprue–like pattern but also panlymphocytic digestive disease. Burbure N et al Hum Pathol 2016. 127_134 Ianiro G et al Aliment Pharmacol Ther 2014, 401: 16-23 Rubio-Tapia A et al Mayo Clinic Proc 2012 87: 732-738
