Fatal Angioedema Associated with Enalapril.

Abstract

A 37-year-old female with a history of hypertension for 5 years was brought to the emergency room with swelling of the tongue and neck after the second dose of enalapril. After administration of hydrocortisone by her physician, she went to the emergency room. Her dyspnea and dysarthria were relieved. However, she experienced recurrence of the symptomsfollowed by respiratory arrest. She suffered severe anoxic brain damage and died three days later. Although angioedema is a rare occurrence with the use of enalapril, it is potentially life threatening. (Internal Medicine 32: 308-310, 1993)

Ramipril induced polyserositis with pericardial tamponade and pleural effusion

“…The angioedema is usually located in the face but arms, legs, scrotum, and the intestinal tract may also be a possible site. This complication might be life threatening when the oropharyngeal tract is affected [3]. To our knowledge, this is the first description that the pleura and the pericardium can also be a site of angioedema during ACE-inhibitor treatment.…”

Unusual Radiographic Appearance of Drug-Induced Pharyngeal Angioedema and Differential Considerations

“…3 In fact, cases have been reported of angioedema occurring years after the drug was first started. 1 The severity of the reaction can also vary, with some cases spontaneously resolving, whereas others rapidly progress to airway compromise. Treatment consists of stopping the medication, instituting steroids and antihistamines, and supportive care for airway protection.…”

“…2 Given the risk of airway compromise, some patients may require intubation. 1 A review of the literature suggests that ACE-I-induced angioedema primarily is localized in the head and neck, especially in the face, mouth, tongue, lips, and larynx. 3 Intestinal/ visceral angioedema is thought to be more rare in ACE-Iinduced cases, being seen more often in organ transplant recipients and C1-esterase deficiency.…”

“…1 Generally well tolerated, these medications have a well-known association with head and neck angioedema-swelling of the facial, labial, lingual, laryngeal, and glossopharyngeal tissues. Although this side effect is well known among clinicians, the imaging characteristics have not been well described in the extant literature, and the protean imaging manifestations of this disorder can lead to misdiagnosis.…”

Brief review: Angiotensin converting enzyme inhibitors and angioedema: anesthetic implications

“…A significant number of patients now present to the emergency department with this complication. 9,10 Life-threatening intraoperative and postoperative angioedema related to ACEI drugs has also been reported, [11][12][13] In view of the number of clinical indications and ever-increasing use of ACEI drugs, this potentially life-threatening adverse reaction [14][15][16][17][18][19][20] needs to be highlighted.…”