First Description of Sprue-Like Enteropathy due to Azilsartan: A Case Report.

INTRODUCTION

Sartan-induced enteropathy is an uncommon side effect of treatment with angiotensin II receptor antagonists (ARBs), which has predominantly been described for olmesartan.

CASE PRESENTATION

For the first time, we describe sartan-induced enteropathy as an adverse drug reaction associated with azilsartan in a 74-year-old male patient who was admitted to the hospital twice within 5 months because of excessive non-bloody diarrhea and weight loss. In this case, histopathological findings of intraepithelial lymphocytosis and intestinal villous atrophy resembled celiac disease; however, celiac disease-specific antibodies remained negative, and a gluten-free diet did not result in significant clinical recovery, while symptoms stopped rapidly after stopping azilsartan. When the patient was seen 5 months later, he was free of clinical symptoms, and histological changes disappeared after stopping azilsartan.

CONCLUSION

This case illustrates sprue-like enteropathy as a potential side effect of azilsartan, emphasizing to consider this differential diagnosis in ARB-treated patients with chronic diarrhea. The causality of our findings was confirmed by drug de-challenge and re-challenge resulting in typical histological changes.