Candesartan-Induced Enteropathy That Mimics Celiac Disease in a 90-Year-Old Patient

Sprue-like enteropathy (SLE) is a clinical syndrome similar to celiac disease and has been associated with the use of various angiotensin receptor blockers (ARBs), a class of medications frequently used in the management of hypertension. Currently, there has only been one documented case report which has observed this occurrence with the use of the ARB candesartan. A 90-year-old female patient presented with chronic diarrhea and weight loss of unclear etiology. Diagnostic esophagogastroduodenoscopy and ileocolonoscopy were macroscopically unremarkable, but histological samples revealed complete villous atrophy, chronic mucosal inflammation, and intraepithelial T-lymphocytic infiltration. However, serological studies could not confirm celiac disease as a cause for the patient’s symptoms of malabsorption. After exclusion of other intestinal inflammation etiologies with noted ongoing candesartan use, the diagnosis of SLE was made, and candesartan therapy was discontinued. Additionally, we decided to initiate a lactose-free diet. Clinical remission was achieved without any recurrences. Candesartan is a commonly prescribed therapeutic agent in the treatment of hypertension. Our case underlines the importance of considering it as a potential cause for unexplained symptoms of malabsorption.

The diagnostic challenge of abdominal tuberculosis in nonendemic countries: A case series from a tertiary hospital in Germany

Abdominal tuberculosis is a rare clinical condition in nonendemic countries and should be included as differential diagnosis by unspecific abdominal complaints, especially in patients with immigration background from high-prevalence regions.

[Off-label use of Budesonide suspensions to treat a patient with lymphocytic esophagitis]

BACKGROUND

Lymphocytic esophagitis (LyE) is a rare chronic inflammatory disease of the esophagus, which shares clinical characteristics with the eosinophilic esophagitis. The most important part of its treatment is proton pump inhibitors (PPIs). Referring to locally acting steroids, evidence-based treatment strategies are missing.

CASE REPORT

A 62-year-old patient presented for evaluation of his chronic dysphagia with previously diagnosed multiple oesophageal stenoses. Endoscopy revealed diffusely distributed esophageal rings and furrows and the diagnosis of LyE was established after immunohistochemical analysis of multiple mucosal biopsies. We initiated therapy with budesonide in the form of capsules (Entocort 3 × 3 mg Hartkapseln^® once daily). During the course of the treatment, we initiated the off-label use of suspensions (Budenobronch^® 0.5 mg twice daily) routinely used in the treatment of patients with asthma or COPD to increase the patient΄s acceptance of this therapy which was diminished because of his dysphagia. Under this therapy, clinical and later histological remission was achieved.

CONCLUSION

Our case report is meant to describe an empirical therapeutic concept, which led to clinical and histological remission of chronic LyE.

[Off-label use of Budesonide suspensions to treat a patient with lymphocytic esophagitis]

Background Lymphocytic esophagitis (LyE) is a rare chronic inflammatory disease of the esophagus, which shares clinical characteristics with the eosinophilic esophagitis. The most important part of its treatment is proton pump inhibitors (PPIs). Referring to locally acting steroids, evidence-based treatment strategies are missing. Case Report A 62-year-old patient presented for evaluation of his chronic dysphagia with previously diagnosed multiple oesophageal stenoses. Endoscopy revealed diffusely distributed esophageal rings and furrows and the diagnosis of LyE was established after immunohistochemical analysis of multiple mucosal biopsies. We initiated therapy with budesonide in the form of capsules (Entocort 3 × 3 mg Hartkapseln^® once daily). During the course of the treatment, we initiated the off-label use of suspensions (Budenobronch^® 0.5 mg twice daily) routinely used in the treatment of patients with asthma or COPD to increase the patient΄s acceptance of this therapy which was diminished because of his dysphagia. Under this therapy, clinical and later histological remission was achieved. Conclusion Our case report is meant to describe an empirical therapeutic concept, which led to clinical and histological remission of chronic LyE.