Olmesartan-associated enteropathy presenting as severe malnutrition
- 1Division of Hospital Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- 2Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- 3Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
Abstract
A woman in her late 70s presented with 14 months of refractory diarrhoea and 32% unintentional weight loss, meeting Global Leadership Initiative on Malnutrition criteria for severe malnutrition. Olmesartan, a component of fixed-dose combination antihypertensive therapy, went unrecognised during five encounters at three institutions. Targeted treatment of hypercalcaemia-related diarrhoea, pancreatic insufficiency, small intestinal bacterial overgrowth and suspected coeliac disease, together with empiric budesonide, failed. At the sixth encounter, component-level medication reconciliation identified olmesartan and revealed repeated improvement when olmesartan had not been administered during prior hospitalisations. Biopsies obtained during push enteroscopy were consistent with olmesartan-associated enteropathy, prompting permanent withdrawal (Naranjo score +9, definite adverse drug reaction). At 2-month follow-up, she had gained 4.8 kg with symptom resolution. Two obstacles contributed to the delay. Brand-name documentation of fixed-dose combination products obscured olmesartan on medication lists, and drug-induced diarrhoea was not considered during the evaluation.
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BibTeX
@article{mpanda2026olmesartanassociated,
title = {{Olmesartan-associated enteropathy presenting as severe malnutrition}},
author = {Alinafe Mpanda and Mariame Sylla and Eric D Young},
journal = {BMJ Case Reports},
year = {2026},
month = oct,
doi = {10.1136/bcr-2026-275970},
url = {https://doi.org/10.1136/bcr-2026-275970},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Olmesartan-associated enteropathy presenting as severe malnutrition
AU - Alinafe Mpanda
AU - Mariame Sylla
AU - Eric D Young
PY - 2026
DA - 2026/10/27
JO - BMJ Case Reports
DO - 10.1136/bcr-2026-275970
UR - https://doi.org/10.1136/bcr-2026-275970
AB - A woman in her late 70s presented with 14 months of refractory diarrhoea and 32% unintentional weight loss, meeting Global Leadership Initiative on Malnutrition criteria for severe malnutrition. Olmesartan, a component of fixed-dose combination antihypertensive therapy, went unrecognised during five encounters at three institutions. Targeted treatment of hypercalcaemia-related diarrhoea, pancreatic insufficiency, small intestinal bacterial overgrowth and suspected coeliac disease, together with empiric budesonide, failed. At the sixth encounter, component-level medication reconciliation identified olmesartan and revealed repeated improvement when olmesartan had not been administered during prior hospitalisations. Biopsies obtained during push enteroscopy were consistent with olmesartan-associated enteropathy, prompting permanent withdrawal (Naranjo score +9, definite adverse drug reaction). At 2-month follow-up, she had gained 4.8 kg with symptom resolution. Two obstacles contributed to the delay. Brand-name documentation of fixed-dose combination products obscured olmesartan on medication lists, and drug-induced diarrhoea was not considered during the evaluation.
SN - 1757-790X
ER -