Olmesartan-associated enteropathy presenting as severe malnutrition
Year: 2026
Type: article
Study design: Case Report
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.
Source: BMJ Case Reports
Authors: Alinafe Mpanda, Mariame Sylla, Eric D Young
Institutions: Johns Hopkins University, Johns Hopkins Hospital
Language: English
Subfield: Toxicology
Domain: Life Sciences
Open Access status: hybrid
OpenAlex ID: W7223818874