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Although initial investigations did not detect an evident infectious aetiology, a diagnosis of infectious colitis was hypothesised. After supportive care and quick recovery, she was discharged and instructed to resume her prior medications, including olmesartan (used for 1 year) for hypertension. Diarrhoea and renal failure recurred promptly, leading to readmission. Gastroscopy revealed severe villous atrophy and inflammation of the duodenum. However, serological tests for coeliac disease were negative. Olmesartan-related sprue-like enteropathy was diagnosed after discontinuing olmesartan, leading to clinical improvement without a gluten-free diet. This case emphasised the importance of considering iatrogenic causes in severe enteropathy differential diagnosis, particularly olmesartan-related complications in patients presenting with sprue-like symptoms, watery diarrhoea and acute renal failure.<\/jats:p>","DOI":"10.1136\/bcr-2025-266248","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T13:55:24Z","timestamp":1770299724000},"page":"e266248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Olmesartan-related sprue-like enteropathy presenting as severe diarrhoea"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1054-105X","authenticated-orcid":false,"given":"Silvia","family":"Suardi","sequence":"first","affiliation":[{"name":"Department of Medicine, Unit of Internal Medicine B, University of Verona School of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico \"G.B. 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