Oertelt-Prigione et al. Journal of Medical Case Reports 2010, 4:141 http://www.jmedicalcasereports.com/content/4/1/141 mon treatment should be rigorously evaluated in such high-risk patients. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors' contributions SOP and AC were responsible for patient care and wrote the paper, MG sug- gested the pathogenetic mechanism and reviewed the paper, EV was respon- sible for patient care, MP edited and reviewed the paper and MZ reviewed the paper. All authors read and approved the final manuscript. Author Details 1Institute of Gender in Medicine, Charité - Universitätsmedizin, Luisenstrasse 65, 10115 Berlin, Germany, 2Division of Internal Medicine and Liver Unit, Department of Medicine, Surgery and Dentistry, San Paolo Hospital School of Medicine, University of Milan, via di Rudiní 8, 20142, Milan, Italy, 3Nephrology and Dialysis Unit, San Paolo Hospital, University of Milan, via di Rudiní 8, 20142, Milan, Italy and 4Department of Internal Medicine, IRCCS Istituto Clinico Humanitas, via A Manzoni 113, 20089 Rozzano, Italy Received: 14 October 2009 Accepted: 19 May 2010 Published: 19 May 2010 JT©oh2uis0rnia1sr0taliOnoclfeOMritpsedalntiv-cPaAriclagCbeiaolsenefaRroempticao:elrh;dlstic2spe0t:nr/1isb0weu,ew4teB:w1di4o.ju1mMnedeirCctaehlncetarsaelrLmetpdso.rftsh.ceomCr/ecaotnivtenCto/4m/1m/o14n1sAt ributionLicense(ht p:/ creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. References 1. Mogensen CE, Neldam S, Tikkanen I, Oren S, Viskoper R, Watts RW, Cooper ME: Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non- insulin dependent diabetes: The candesartan and lisinopril microalbuminuria CALM study. BMJ 2000, 7274:1440-1444. 2. Mann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H, Pogue J, Wang X, Maggioni A, Budaj A, Chaithiraphan S, Dickstein K, Keltai M, Metsarinne K, Oto A, Parkhomenko A, Piegas LS, Svendsen TL, Teo KK, Yusuf S: Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet 2008, 9638:547-553. 3. Matchar DB, McCrory DC, Orlando LA, Patel MR, Patel UD, Patwardhan MB, Powers B, Samsa GP, Gray RN: Systematic review: Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med 2008, 1:16-29. 4. Doulton TW, He FJ, MacGregor GA: Systematic review of combined angiotensin-converting enzyme inhibition and angiotensin receptor blockade in hypertension. Hypertension 2005, 5:880-886. 5. Weir MR, Smith DH, Neutel JM, Bedigian MP: Valsartan alone or with a diuretic or ACE inhibitor as treatment for African American hypertensives: Relation to salt intake. Am J Hypertens 2001, 7(Pt 1):665-671. 6. Cohn JN, Tognoni G: A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001, 23:1667-1675. 7. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, Anderson C: Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008, 15:1547-1559. 8. Nakao N, Yoshimura A, Morita H, Takada M, Kayano T, Ideura T: Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): A randomised controlled trial. Lancet 2003, 9352:117-124. 9. Kunz R, Friedrich C, Wolbers M, Mann JF: Meta-analysis: Effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med 2008, 1:30-48. Page 4 of 4 10. Nagami GT: Ammonia production and secretion by S3 proximal tubule segments from acidotic mice: Role of ANG II. Am J Physiol Renal Physiol 2004, 4:F707-712. doi: 10.1186/1752-1947-4-141 Cite this article as: Oertelt-Prigione et al., Severe hepatic encephalopathy in a patient with liver cirrhosis after administration of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker combination therapy: a case report Journal of Medical Case Reports 2010, 4:141