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Olmesartan-medoxomil Drug-induced enteropathy with various presentations: 3 case reportsIn a case series, 3 patients (2 males and 1 female) aged 74-86 years were described, who developed olmesartan-induced enteropathy with various presentations during treatment with olmesartan medoxomil for high blood pressure [routes and frequencies not stated].Case 1 (an 83-year-old man): The man, who had been receiving olmesartan medoxomil 40mg for the past 5 years, presented due to diarrhoea and anorexia. Upon examination, hypotension, dehydration of the mucous membranes, increased peristalsis and abdominal tympanism were noted. He was therefore admitted. Upon admission, impaired renal function (creatinine 1.8 mg/dL) and an elevated C-reactive protein levels were detected. A thoracoabdominal CT-scan exhibited abundant fluid in the colon. The stool cultures and the toxin and antigen tests were negative for Clostridium difficile. During the hospitalisation, he was treated with unspecified antibiotics and fluid therapy. Olmesartan medoxomil was stopped due to the clinical suspicion of olmesartan-induced enteropathy. After 8 days, he was discharged following improvement in the symptoms. At a follow-up after 2 years, he continued to be asymptomatic.Case 2 (an 86-year-old woman): The multipathological woman had been receiving olmesartan medoxomil 40mg for 3 years along with other unspecified concomitant medications. Over the course of past 2 months, she consulted for diarrhoea, and was admitted four times due to prerenal insufficiency and metabolic acidosis. An abdominal ultrasound showed an increase in intraluminal fluid. Gastrin and calcitonin were found to be normal. Colonoscopy exhibited superficial ulcers from the rectum to the caecum, which were consistent with chronic colitis, and a lack of villi, superficial ulcers and a cobbled pattern in the ileum. The biopsy revealed chronic and mild active ileitis. Olmesartan medoxomil was stopped due to the clinical suspicion of olmesartan-induced enteropathy presented as chronic colitis and active ileitis [time to reactions onsets not stated]. Gradually, she showed a clinical improvement. Three months following the discharge, she did not report any diarrhoea.Case 3 (a 74-year-old man): The man was multipathological and polymedicated. He had been receiving olmesartan medoxomil 40mg for 6 years. He sought consultation twice for epigastralgia, nausea, vomiting and diarrhoea of 2 weeks of evolution, dizziness, instability and tremor. His blood tests, chest and abdominal radiography and brain CT-scan were unremarkable. He was thus admitted. Upon admission, hypocalcaemia and hypomagnesaemia were noted, which improved with supplementation. Additionally, signs of malabsorption stood out. Gastroscopy revealed olmesartan-induced enteropathy presented as erosive duodenitis with pathological findings of olmesartan-induced enteritis. Olmesartan medoxomil was therefore stopped. Eight months following the discontinuation, he did not report any diarrhoea.
Olmesartan-medoxomil Drug-induced enteropathy with various presentations: 3 case reportsIn a case series, 3 patients (2 males and 1 female) aged 74-86 years were described, who developed olmesartan-induced enteropathy with various presentations during treatment with olmesartan medoxomil for high blood pressure [routes and frequencies not stated].Case 1 (an 83-year-old man): The man, who had been receiving olmesartan medoxomil 40mg for the past 5 years, presented due to diarrhoea and anorexia. Upon examination, hypotension, dehydration of the mucous membranes, increased peristalsis and abdominal tympanism were noted. He was therefore admitted. Upon admission, impaired renal function (creatinine 1.8 mg/dL) and an elevated C-reactive protein levels were detected. A thoracoabdominal CT-scan exhibited abundant fluid in the colon. The stool cultures and the toxin and antigen tests were negative for Clostridium difficile. During the hospitalisation, he was treated with unspecified antibiotics and fluid therapy. Olmesartan medoxomil was stopped due to the clinical suspicion of olmesartan-induced enteropathy. After 8 days, he was discharged following improvement in the symptoms. At a follow-up after 2 years, he continued to be asymptomatic.Case 2 (an 86-year-old woman): The multipathological woman had been receiving olmesartan medoxomil 40mg for 3 years along with other unspecified concomitant medications. Over the course of past 2 months, she consulted for diarrhoea, and was admitted four times due to prerenal insufficiency and metabolic acidosis. An abdominal ultrasound showed an increase in intraluminal fluid. Gastrin and calcitonin were found to be normal. Colonoscopy exhibited superficial ulcers from the rectum to the caecum, which were consistent with chronic colitis, and a lack of villi, superficial ulcers and a cobbled pattern in the ileum. The biopsy revealed chronic and mild active ileitis. Olmesartan medoxomil was stopped due to the clinical suspicion of olmesartan-induced enteropathy presented as chronic colitis and active ileitis [time to reactions onsets not stated]. Gradually, she showed a clinical improvement. Three months following the discharge, she did not report any diarrhoea.Case 3 (a 74-year-old man): The man was multipathological and polymedicated. He had been receiving olmesartan medoxomil 40mg for 6 years. He sought consultation twice for epigastralgia, nausea, vomiting and diarrhoea of 2 weeks of evolution, dizziness, instability and tremor. His blood tests, chest and abdominal radiography and brain CT-scan were unremarkable. He was thus admitted. Upon admission, hypocalcaemia and hypomagnesaemia were noted, which improved with supplementation. Additionally, signs of malabsorption stood out. Gastroscopy revealed olmesartan-induced enteropathy presented as erosive duodenitis with pathological findings of olmesartan-induced enteritis. Olmesartan medoxomil was therefore stopped. Eight months following the discontinuation, he did not report any diarrhoea.
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