Pantoprazole-induced enteropathy: An unexpected cause of seronegative villous atrophy

Seronegative villous atrophy (SNVA) presents a diagnostic challenge with a wide range of possible etiologies. This report details a 67-year-old woman who developed chronic watery diarrhea and weight loss following the initiation of pantoprazole for gastroesophageal reflux disease. Duodenal biopsies showed villous atrophy associated with intraepithelial lymphocytosis, while celiac serologies and HLA-DQ2/DQ8 gene testing were negative. Discontinuation of pantoprazole led to the resolution of symptoms, and follow-up biopsies showed normalizes duodenal villous architecture without inflammatory infiltrates. This case represents an association between pantoprazole and the development of seronegative villous atrophy, underscoring the need to consider medications as potential causes of enteropathy.