[A new spruelike disease as a cause of severe diarrhea]

History and presentation at admission: A 77-years old woman presented with an 8-week history of pronounced diarrhea and weight loss of 10 kg.

Infectious enteritis and chronic inflammatory bowel disease were excluded. Duodenal biopsies showed villous atrophy and 50 intraepithelial lymphocytes per 100 enterocytes, but antibody testing for celiac disease was negative.

The diarrhea resolved within 2 weeks after withdrawing olmesartan, which she had received for hypertension for 5 years, without a gluten-free diet. 6 months later the histological abnormalities in the duodenum regressed markedly. A diagnosis of sprue-like enteropathy associated with olmesartan was made.

The syndrome is probably rare and was first described in 2012. It should be suspected in patients on olmesartan treatment who have clinical and histological findings, but not serological markers of celiac disease.