Chronic diarrhoea is a common clinical problem in gastroenterology practice and often it is difficult to diagnose the cause. Villous atrophy is not specific and the rarer possibility of drug-induced enteritis should always be considered. Olmesartan has recently been described as a cause of drug-induced enteropathy characterized by chronic diarrhoea and varying degrees of duodenal mucosa atrophy resembling celiac disease.We describe two cases of sprue-like enteropathy in patients treated with olmesartan for arterial hypertension several years before the onset of symptoms. Patients presented severe diarrhoea and significant weight loss, and both had histological evidence of intestinal villous atrophy. The clinical signs completely resolved after drug withdrawal.Olmesartan-induced enteropathy is a new clinical entity that must be included in the differential diagnosis of villous atrophy with negative celiac serology. The clinical and histological alterations easily and completely resolve after drug discontinuation, restoring quality of life to patients and avoiding unnecessary investigation.

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We report a clinical case of adult-onset Still's disease. In addition to the imaging features of the case, the following aspects are also briefly described: clinical presentation (prolonged fever associated with migratory polyarthritis and skin rash), treatment performed (resort to anti-inflammatory and corticoid), and clinical evolution of the patient after having performed the adult-onset. The treatment was found to be appropriate as the patient presented a favourable clinical evolution. LEARNING POINTS • Skin manifestations are associated with systemic diseases. • Persistent febrile syndromes typically occur in young age. • Adult-onset Still's disease is generally considered as a diagnosis of exclusion, as it presents with a combination of non-specific symptoms.

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DRESS syndrome is a rare and potentially fatal multisystemic reaction that occurs two to six weeks after exposure to certain drugs. It is characterized by fever, eosinophilia, and skin rash. Case of a 37-year-old man, black, with gout (started allopurinol 4 weeks before). He arrived at the Emergency Room complaining of headache, fever, abdominal pain, and scattered maculopapular skin lesions. The conducted study showed elevated transaminases and C-reactive protein, hepatomegaly, and peri-hepatic adenomegalies. Allopurinol was stopped, but throughout hospitalization, liver, renal and neurological dysfunctions (with meningoencephalitis) worsened; it also appeared eosinophilia. A skin biopsy was performed, the possibility of DRESS syndrome was assumed, and methylprednisolone 2 mg/kg/day was started, with progressive improvement. The skin biopsy was compatible with DRESS. The described case reveals some peculiarities. Among the most relevant arethe late onset of eosinophilia and the difficulty in evaluating the rash due to the patient's skin tone and neurological manifestations (rare).