Supplementary Material for: First Description of Sprue-like Enteropathy due to Azilsartan: A Case Report

Introduction: Sartan-induced enteropathy is a rare 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 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 intestinal villous atrophy and intraepithelial lymphocytosis resembled celiac disease; however, celiac disease-specific antibodies remained negative, and a gluten-free diet did not result in clinical improvement, 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, through azilsartan exposure, de-challenge, and re-challenge combined with the clinical and histological findings, sprue-like enteropathy as a potential side effect of azilsartan, emphasizing to consider this differential diagnosis in ARB-treated patients with chronic diarrhea.