Chronic diarrhoea, weight loss and a positive anti-tissue transglutaminase antibody: A case report of olmesartan-induced enteropathy

BMJ Case Rep. 2024 May 6;17(5):e255407. doi: 10.1136/bcr-2023-255407.

Abstract

Olmesartan is an angiotensin II receptor blocker licensed for the treatment of hypertension. It can cause a sprue-like enteropathy (SLE), characterised by chronic diarrhoea, weight loss and villous atrophy. Transiently raised anti-tissue transglutaminase (ATTG) antibody has also been rarely reported in the literature.We describe the case of a woman in her mid-50s, who presented with a history of intermittent loose stools over 1 year, associated with significant weight loss. She had two marginally raised serum ATTG antibody tests during her work-up.After extensive investigations, she was diagnosed with olmesartan-induced enteropathy. On subsequent follow-up, her symptoms had resolved with cessation of her olmesartan therapy.This case adds to existing literature, highlighting the importance of considering olmesartan as a possible differential diagnosis for SLE. It also reports the presence of a raised ATTG antibody which is infrequently reported in this context.

Keywords: Cardiovascular system; Drugs: gastrointestinal system; Gastroenterology; Malabsorption; Stomach and duodenum.

Publication types

  • Case Reports

MeSH terms

  • Angiotensin II Type 1 Receptor Blockers / adverse effects
  • Autoantibodies / blood
  • Celiac Disease / diagnosis
  • Chronic Disease
  • Diagnosis, Differential
  • Diarrhea* / chemically induced
  • Female
  • GTP-Binding Proteins / antagonists & inhibitors
  • GTP-Binding Proteins / immunology
  • Humans
  • Imidazoles* / adverse effects
  • Middle Aged
  • Protein Glutamine gamma Glutamyltransferase 2
  • Tetrazoles* / adverse effects
  • Transglutaminases* / immunology
  • Weight Loss*

Substances

  • olmesartan
  • Imidazoles
  • Tetrazoles
  • Transglutaminases
  • Angiotensin II Type 1 Receptor Blockers
  • Autoantibodies
  • Protein Glutamine gamma Glutamyltransferase 2
  • GTP-Binding Proteins