JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
CLINICAL CASE OF THE MONTH
An Extreme Presentation of Angiotensin Converting Enzyme Inhibitor-Induced Angioedema
Ian Wisecarver, Sanjay Kamboj, MD, David Galambos, Michelle Korah-Sedgwick, MD, Ross McCarron, MD, Fred Lopez, MD
INTRODUCTION
pharyngeal swelling at this time. There was no appreciable urticaria or erythematous lesions on dermatologic examination. An examination of the patient’s lungs revealed no wheezes or decreased breath sounds.
Angiotensin converting enzyme (ACE) inhibitor associated angioedema is an adverse drug reaction that can result in potentially life-threatening swelling of soft tissue including the lips, pharynx, and larynx. The patient presented in this case is an African American man with no prior history of angiotensin converting enzyme inhibitor usage. He was admitted to the hospital due to concerns that the edema involving his face would worsen to the point of airway compromise. The patient needed an emergent bedside intubation and remained in the hospital for six days. The intent of this report is to briefly explain the epidemiology, clinical presentation, method of diagnosis, and treatment of ACE inhibitor associated angioedema.
CASE PRESENTATION
A 72 year-old African American man with a past medical history of hypertension, heart failure with reduced ejection fraction, and alcohol use presented to the emergency department (ED) with a chief complaint of a one day history of facial swelling (Figure 1). On the day prior to presentation, the patient noted that he took a dose of a friend’s lisinopril in an attempt to relieve atraumatic left lower leg swelling. The swelling had been present for the past week and he believed it was caused by his previously diagnosed heart failure. Upon awakening the next morning, he noticed new onset lip swelling and took another tablet of lisinopril in an attempt to relieve the swelling. The swelling in his lips progressively worsened throughout the day, prompting him to seek medical attention at the hospital. On presentation to the hospital, the patient denied difficulty breathing, throat swelling, and any previous history of allergic reactions. The patient was afebrile, normotensive, tachycardic, his oxygen saturation was 99% on ambient air, and he was in no apparent distress. He had significant non-pitting, non- erythematous edema of both his upper and lower lips, left cheek, left periorbital area, and mild edema of the right periorbital area. He did not show any signs of lingual or posterior
Figure 1: Patient upon presentation to the Emergency Department.
J La State Med Soc VOL 169 NOVEMBER/DECEMBER 2017 171
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