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CASE REPORT
Rare case of losartan-induced cough complicated by rectus sheath haematoma: in a patient on rivaroxaban therapy
  1. Goutham Talari1,
  2. Preetham Talari1,
  3. Joseph Sweigart1,
  4. Sadiq Ahmed2
  1. 1Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
  2. 2Department of Internal Medicine—Nephrology, University of Kentucky Medical Center, Lexington, Kentucky, USA
  1. Correspondence to Dr Talari Goutham, goutham.talari{at}uky.edu

Summary

Spontaneous rectus sheath haematomas and cough secondary to losartan are individually rare conditions. Abdominal wall haematomas present with abdominal pain and abdominal mass. Most patients are managed conservatively; Surgery or embolisation is indicated for shock, infection, rupture into the peritoneum or intractable pain. This is a man aged 65 years presented with dry cough and right-sided abdominal pain. He started losartan a few weeks prior to the onset of cough and had been on rivaroxaban for prior deep venous thrombosis. The right side of his abdomen was distended, bruised and tender. His haemoglobin dropped from 13.3to 9.5 g/dL. CT abdomen/pelvis showed a large 14.5×9.1×4.5 cm haematoma within the right lateral rectus muscle. His only risk factor for developing rectus sheath haematoma was cough in the setting of anticoagulation. Dry cough due to angiotensin receptor blockers is rare, but can have very serious consequences.

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Footnotes

  • Contributors GT identified the condition, involved in literature search and prepared the manuscript. PT is responsible for drafting and revision. JS is responsible for editing manuscript and final revision. SA is responsible for literature search, expert opinion, revision and final approval of the draft.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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