1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2014, Issue 2
  5. Article
Volume 2014, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

ACE inhibitors accounts for 8% of all cases of angioneurotic edema and the overall incidence is 0.1 to 0.7% of patients on ACE inhibitors. It is a leading cause (20-40%) of emergency room visits in the US with angioedema. We report a case of angioedema caused by ACE inhibitors confined to the upper airway after four years on treatment with Lisinopril which persisted for three weeks and required endotracheal intubation and subsequent tracheostomy due to delayed resolution. This case is one of the rare cases presented as upper airway edema which persisted for a long time. A 60-year-old Sudanese male patient with osteoarthritis in both knees underwent bilateral total knee replacement under single-shot epidural anesthesia. He had significant past medical history of type II diabetes, bipolar affective disorder and hypertension managed with Lisinopril for the past four years. Postoperatively after 10 hours the patient desaturated and developed airway obstruction requiring intubation. Laryngoscopy revealed an edematous tongue and upper airway and vocal cords were not visualized. In view of this clinical picture a provisional diagnosis of angioedema secondary to Lisinopril was made and it was discontinued. CT scan of the neck and soft tissues revealed severe airway edema with snugly fitting endotracheal tube with no peritubal air. A repeat CT neck on the tenth postoperative day showed no signs of resolution and an elective tracheostomy was performed on the eleventh postoperative day. C1 inhibitor protein and C4 levels were assayed to exclude hereditary angioedema and were found to be within normal range. Decannulation of tracheostomy was done after airway edema resolved on the twenty-fourth postoperative day as confirmed by CT scan. Subsequently he was transferred to the ward and discharged home. ACEI induced angioedema is a well-recognized condition. Early diagnosis based on a high index of suspicion, immediate withdrawal of the offending drug followed by supportive therapy is the cornerstone of management.

© 2014 Tharayil, Chanda, Shiekh, ElKhatib, Nayeemuddin, Alshamandy, licensee Bloomsbury Qatar Foundation Journals.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2014.15
2015-02-01
2024-11-14
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2014/2/qmj.2014.15.html?itemId=/content/journals/10.5339/qmj.2014.15&mimeType=html&fmt=ahah

References

  1. Hide M, Hiragun T. Japanese guidelines for diagnosis and treatment of urticaria in comparison with other countries. Allergology International. 2012; 61:: 517–527.
     [Google Scholar]
  2. Messerli FH, Nussberger J. Vasopeptidase inhibition and angio-oedema. Lancet. 2000; 356:9230: 608–609.
     [Google Scholar]
  3. Banerji A, Clark S, Blanda M, LoVecchio F, Snyder B, Camargo CA Jr. Multicenter study of patients with angiotensin-converting enzyme inhibitor-induced angioedema who present to the emergency department. Ann Allergy Asthma Immunol. 2008; 100:4:327–332.
     [Google Scholar]
  4. Chiu AG, Newkirk KA, Davidson BJ, Burningham AR, Krowiak EJ, Deeb ZE. Angiotensin-converting enzyme inhibitor-induced angioedema: A multicenter review and an algorithm for airway management. Ann Otol Rhinol Laryngol. 2001; 110:9:834–840.
     [Google Scholar]
  5. Norman JL, Holmes WL, Bell WA, Finks SW. Life-threatening ACE inhibitor-induced angioedema after eleven years on lisinopril. J Pharm Pract. 2013; 26:4:382–388.
     [Google Scholar]
  6. Morimoto T, Gandhi TK, Fiskio JM, Seger AC, So JW, Cook EF, Fukui T, Bates DW. An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors. J Eval Clin Pract. 2004; 10::499–509.
     [Google Scholar]
  7. Cicardi M, Agostini A. Hereditary angioedema. N Engl J Med. 1996; 334::1666–1667.
     [Google Scholar]
  8. Vasekar M, Craig TJ. ACE inhibitor-induced angioedema. Curr Allergy Asthma Rep. 2012; 12:1:72–78.
     [Google Scholar]
  9. Kanani A, Schellenberg R, Warrington R. Urticaria and angioedema. Allergy Asthma Clin Immunol. 2011; 7:Suppl 1:S9.
     [Google Scholar]
  10. Chin HL, Buchan DA. Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor. Ann Intern Med. 1990; Feb 15 112:4: 312–313.
     [Google Scholar]
  11. Slater EE, Merrill DD, Guess HA, Roylance PJ, Cooper WD, Inman WH, Ewan PW. Clinical profile of angioedema associated with angiotensin converting enzyme inhibition. JAMA 1988; 260:: 967–970.
     [Google Scholar]
  12. Grant NN, Deeb ZE, Chia SH. Clinical experience with angiotensin-converting enzyme inhibitor induced angioedema. Otolaryngol Head Neck Surg. 2007; Dec 137:6:931–935.
     [Google Scholar]
  13. Inomata N. Recent advances in drug-induced angioedema. Allergol Int. 2012; 61:4:545–557.
     [Google Scholar]
  14. Shiber JR. Images in clinical medicine. Angioedema of the arytenoids. N Engl J Med. 2005; 353:17:e15.
     [Google Scholar]
  15. Agostoni A, Cicardi M. Hereditary and acquired C1-inhibitor deficiency: Biological and clinical characteristics in 235 patients. Medicine (Baltimore). 1992; 71::206–215.
     [Google Scholar]
  16. Thompson T, Frable MA. Drug-induced, life-threatening angioedema revisited. Laryngoscope. 1993; 103::10–12.
     [Google Scholar]
  17. Weber MA, Messerli FH. Angiotensin-converting enzyme inhibitors and angioedema: Estimating the risk. Hypertension. 2008; 51::1465–1467.
     [Google Scholar]
  18. Bas M, Greve J, Stelter K, Bier H, Stark T, Hoffmann TK, Kojda G. Therapeutic efficacy of icatibant in angioedema induced by angiotensin-converting enzyme inhibitors: A case series. Ann Emerg Med. 2010; 56:3:278–282.
     [Google Scholar]
  19. Karim MY, Masood A. Fresh-frozen plasma as a treatment for life-threatening ACE-inhibitor angioedema. J Allergy Clin Immunol. 2002; 109:2: 370–371.
     [Google Scholar]
  20. Nielsen EW, Gramstad S. Angioedema from angiotensin-converting enzyme (ACE) inhibitor treated with complement 1 (C1) inhibitor concentrate. Acta Anaesthesiol Scand. 2006; 50:1:120–122.
     [Google Scholar]
/content/journals/10.5339/qmj.2014.15
Loading
Life threatening angioedema in a patient on ACE inhibitor (ACEI) confined to the upper airway
Qatar Medical Journal 2014, 15 (2015); https://doi.org/10.5339/qmj.2014.15
/content/journals/10.5339/qmj.2014.15
/content/journals/10.5339/qmj.2014.15
Loading

Data & Media loading...

Supplements

Supplementary File 1

  • Article Type: Case Report
Keyword(s): ACE inhibitor, angioedema and life threatening.

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error