Olmesartan-induced Enteropathy Manifesting as Wernicke-Korsakoff Syndrome

Abstract

Cases of sprue-like enteropathy associated with olmesartan have sporadically been encountered since it was first reported in 2012, and their most characteristic manifestation is severe diarrhea. We herein report the first case of sprue-like enteropathy manifesting as Wernicke-Korsakoff syndrome due to vitamin B1 malabsorption with only minimally increased bowel movements. When patients are receiving olmesartan and they complain of nonspecific chronic gastrointestinal symptoms, it is important to consider changing the drugs before any serious malabsorption syndrome develops.

Severe Sprue-Like Enteropathy and Colitis due to Olmesartan: Lessons Learned From a Rare Entity

“…In an overwhelming majority of cases of OAE the diagnosis may remain elusive, though fortunately, in our case, we arrived at the diagnosis fairly quickly. Making the diagnosis is particularly challenging and is usually delayed as seen in previously reported cases [ 1 , 6 - 11 ]. Reasons for this are numerous and include the fact that patients present with a spectrum of nonspecific GI symptoms.…”

“…Additionally, a crucial factor to consider that has occurred in previous cases [ 1 , 6 , 7 , 10 , 11 , 13 - 15 ] but not particularly emphasized is how hospitalized patients frequently have their home olmesartan medication temporarily suspended prior to a formal diagnosis. Reasons for this include therapeutic interchange to an alternate ARB due to the institutional formulary, held for medical reasons such as hypotension or acute kidney injury, or held along with all other drugs for suspicion of a possible drug-induced phenomenon of unknown etiology.…”

“…If performed, biopsy typically shows histological improvement or remission in OAE relatively quickly, on the order of months [ 1 , 17 , 18 ]. Re-challenging patients with olmesartan is not recommended, though has occurred unknowingly in previous studies [ 7 , 10 , 11 , 14 ] with resumption of symptoms exhibited. It is not unreasonable at this point in time to consider replacing a patient’s olmesartan to an alternative ARB.…”

Significant Weight Loss in a Patient Taking Olmesartan: An Unusual Case Report

“…Dehydration and acute renal failure are the most frequent causes of hospitalization, even in the Intensive Care Unit (ICU) [6,15]. Other unusual cases of this entity include colonic perforation [24], Wernicke-Korsakoff syndrome due to vitamin B1 malabsorption with minimal gastrointestinal symptoms [25], nonalcoholic steatohepatitis [26] and simultaneous olmesartan-associated uveitis with enteropathy [27]. Furthermore, a case with severe diarrhea, weight loss and a cutaneous lesion histologically indicative of pemphigoid or acquired bullous epidermolysis-like lesions has been reported [28].…”

“…Angiotensin II promotes enterocyte apoptosis, suggesting that olmesartan-associated enteropathy results from excess apoptosis of enterocytes. The high affinity of olmesartan for AT1 receptors may explain the greater incidence of enteropathy with this ARB [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”