Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Espru Colágeno/induzido quimicamente , Olmesartana Medoxomila/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Espru Colágeno/diagnóstico por imagem , Espru Colágeno/patologia , Endoscopia do Sistema Digestório , Feminino , Humanos , Olmesartana Medoxomila/administração & dosagemAssuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Doença Celíaca/complicações , Espru Colágeno/induzido quimicamente , Hipertensão/tratamento farmacológico , Imidazóis/efeitos adversos , Intestino Delgado/efeitos dos fármacos , Conduta do Tratamento Medicamentoso , Tetrazóis/efeitos adversos , Idoso , Atrofia , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Espru Colágeno/diagnóstico , Dieta Livre de Glúten , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Intestino Delgado/patologia , Microvilosidades/efeitos dos fármacos , Microvilosidades/patologia , Fatores de RiscoRESUMO
Collagenous sprue (CS) is a distinct clinicopathological disorder histologically defined by a thickened subepithelial band (Freeman, 2011). It is a rare condition which has been recently observed in a significant proportion of sprue-like enteropathy associated with olmesartan, a novel entity described by Rubio-Tapia et al. in 2012. CS is historically associated with a poor prognosis (Marthey et al., 2014). However, histological and clinical improvements have been described in most studies with concomitant usage of corticosteroids and/or gluten-free diet (Marthey et al., 2014). We report a unique case of olmesartan-induced collagenous sprue in a 79-year-old man that showed complete histological and clinical remission with the sole withdrawal of the incriminating drug. The literature on this topic is briefly reviewed.
Assuntos
Anti-Hipertensivos/efeitos adversos , Espru Colágeno/induzido quimicamente , Imidazóis/efeitos adversos , Tetrazóis/efeitos adversos , Idoso , Diarreia/induzido quimicamente , Humanos , Hipertensão/tratamento farmacológico , Masculino , Suspensão de TratamentoRESUMO
Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient's diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.
Assuntos
Anti-Hipertensivos/efeitos adversos , Espru Colágeno/patologia , Diarreia/patologia , Duodeno/patologia , Imidazóis/efeitos adversos , Tetrazóis/efeitos adversos , Idoso , Atrofia , Biópsia , Espru Colágeno/induzido quimicamente , Diarreia/induzido quimicamente , Humanos , Hipertensão/tratamento farmacológico , Masculino , Vômito/induzido quimicamente , Vômito/patologia , Redução de PesoRESUMO
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.