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Since publication of 22 cases of olmesartan induced sprue like enteropathy by Rubio-Tapia et al. there have been publications of many case reports. It is now documented that olmesartan cause sprue like enteropathy with partial villous atrophy, leading to malabsorption and small bowel diarrhea. Sometimes it resembles celiac, in some it may resemble like collagenous or lymphocytic microscopic colitis. It may involve any parts of gastrointestinal tract. There are few case reports from India. We encountered a middle-aged female with severe diarrhoea leading to dehydration and acute kidney injury. After failed trial of gluten free diet, she responded only when olmesartan was stopped. AIM of reporting this case is- We as a clinician must be aware of this adverse effect of angiotensin receptor II blocker and should have a high index of suspicion so that we can avoid delay in the diagnosis as well as costly, frustrating unnecessary tests.
