Postoperative angioedema induced by angiotensin-converting enzyme inhibitor: case report

Bisinotto, Flora Margarida Barra; Seabra, Beatrice Cavalcanti; Lóes, Fernando B. Prata; Martins, Laura Bisinotto; Silveira, Luciano Alves Matias da

doi:10.1016/j.bjane.2019.09.002

Cited by 4 publications

(8 citation statements)

References 14 publications

(49 reference statements)

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“…ACEi-induced angioedema has an incidence of 0.1-0.7% and is higher in women and African Americans (presumably due to polymorphism in the gene encoding aminopeptide P that is responsible for the metabolism of ACEi). It accounts for approximately one-third of angioedema cases in the emergency department [2,[6][7][8]. Mechanistically, ACEi-induced angioedema is a consequence of excessive levels of bradykinin [6,[9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Angiotensin-converting enzyme inhibitor (ACEi)-induced angioedema is a rare but life-threatening adverse effect of ACEi therapy with an incidence of approximately 0.1-0.7% [1]. There have been numerous instances in which patients with this clinical picture have required intubation or tracheostomy in severe cases [2][3][4][5]. This report presents a case of tracheal stenosis brought about by traumatic intubation.…”

Section: Introductionmentioning

confidence: 99%

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Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

Vazirnia¹,

Choroomi²,

Marfowaa³

et al. 2023

Cureus

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Angiotensin-converting enzyme inhibitor (ACEi)-induced angioedema is a consequence of excessive levels of bradykinin and accounts for nearly a third of angioedema cases when patients present to emergency rooms. While rare, patients can present with swelling in the face, tongue, and airways making it a lifethreatening emergency. To secure an airway, endotracheal intubation may be conducted; however, tracheal stenosis is a known complication. In this report, we present a 61-year-old female with a history of ACEiinduced angioedema care in which she was intubated with facial swelling. Upon a repeat hospitalization, the patient developed stridor with respiratory distress. Bronchoscopy revealed severe tracheal stenosis with multilevel damage to tracheal rings, warranting urgent tracheostomy. One month after discharge, the patient was seen by an ENT specialist who performed a transnasal laryngoscopy revealing near total subglottic and tracheal stenosis of 3 cm stenosis length, presumed secondary to traumatic intubation for prior angioedema management. This case highlights the importance of careful intubation practices in patients with suspected airway edema.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

Vazirnia¹,

Choroomi²,

Marfowaa³

et al. 2023

Cureus

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“…AE from allergic reaction is mediated by antigen-IgE which release inflammatory mediators and histamine from the basophils and mast cells. 3 Effective medication included epinephrine, glucocorticoids, antihistamine and oxygen. [1,4]This patient was administered Diphenhydramine and Methylprednisolone as empiric therapy, with justification that there was possibility of deterioration of the respiratory function.…”

Section: Discussion / Conclusionmentioning

confidence: 99%

A Case of Neurovascular Edema Induced by Propofol

2022

JCMP

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One life threatening manifestation of drug hypersensitivity is angioedema. In some rare cases, propofol may induced angioedema and is proposed to be allergy related. This case report presented a case of angioedema induced by propofol administration in remote area. Limited resources available added another challenge in confirming diagnosis and treating the disease. Nevertheless, identifying and discontinuing the suspected etiology should not be postponed and monitoring intensively should be initiated early to prevent lethal condition.

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“…Angioedema is characterized by an episode of edema that affects the deep dermis and subcutaneous tissue and may involve regions of the face, lip, neck, and extremities 7 . Episodes of angioedema in COVID-19 constitute an atypical manifestation, and its description in the literature is rare.…”

Section: Discussionmentioning

confidence: 99%

“…Episodes of angioedema in COVID-19 constitute an atypical manifestation, and its description in the literature is rare. Angioedema occurs due to an increase in the permeability of submucosal or subcutaneous capillaries and venules due to the presence of chemical mediators such as prostaglandins, proteases, bradykinin, and histamine 7 .…”

Section: Discussionmentioning

confidence: 99%

Angioedema, endothelium, ACE2, and bradykinin - interrelationships in COVID-19: a case report

Florêncio¹,

Tenório

Júnior³

et al. 2020

Medicina (Ribeirão Preto)

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COVID-19 is a new disease, whose several atypical clinical manifestations began to be observed with the evolution of the pandemic, and have been investigated to understand the pathophysiology of the disease. In this article, the objective is to describe a case of angioedema in COVID-19, considered an atypical manifestation, and rarely described in the literature. The case is of a 55-year-old patient who sought medical attention for a complaint of intermittent fever for four days. On the seventh day, he manifested angioedema in the left zygomatic projection and the right subpalpebral region. The patient had no history of angioedema earlier in life. The following day, he presented a regression of the angioedema concerning the previous day. After this period, the patient progressed well and became asymptomatic. The RT-PCR laboratory test performed on the first days of manifesting symptoms was positive for SARS-CoV-2. We correlate the onset of angioedema with the possible endotheliitis present in the disease, which has been evidenced by the observation of severe endothelial injury associated with the intracellular presence of the virus in several histopathological studies of patients with COVID-19. Also, possible deregulation of the Kininogen-Kallikrein-Kinin System (KKKS) could explain this manifestation, as SARS-CoV-2 binds to the ACE2 receptor, which is responsible for degrading kinins, such as bradykinin.

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Postoperative angioedema induced by angiotensin-converting enzyme inhibitor: case report

Cited by 4 publications

References 14 publications

Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema With Resultant Airway Obstruction Following Endotracheal Intubation

A Case of Neurovascular Edema Induced by Propofol

Angioedema, endothelium, ACE2, and bradykinin - interrelationships in COVID-19: a case report

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