Abstract
Angiotensin converting-enzyme (ACE) inhibitors are commonly prescribed drugs with multiple indications including congestive heart failure, hypertension, and diabetic nephropathy. ACE inhibitor induced angioedema is commonly seen across emergency departments and clinics, with transient swelling of lips, tongue, and other facial structures being the common presentation. Isolated airway obstruction as a result of pharyngeal and laryngeal swelling without facial swelling is a rare presentation. We present a case of a patient on lisinopril therapy for one year who experienced severe airway compromise without the classic symptoms of ACE inhibitor induced angioedema. He required emergent cricothyroidotomy to secure his airway, as fiberoptic laryngoscopy showed 90% obstruction and inability to visualize true vocal cords. His ACE inhibitor therapy was discontinued, and he was discharged home within a few days with no residual symptoms.
References
May 1, 1995·The Journal of Emergency Medicine·D C Kuo, R A Barish
Apr 1, 1997·Digestive Diseases and Sciences·M F Abdelmalek, D D Douglas
Apr 15, 1999·American Journal of Otolaryngology·K W AltmanJ E Pappano
Nov 15, 2000·Mayo Clinic Proceedings·T J ByrneJ P Heppell
Sep 18, 2001·The Annals of Otology, Rhinology, and Laryngology·A G ChiuZ E Deeb
Jun 28, 2002·Lancet·Albert AdamAngelo Agostoni
Aug 21, 2002·The American Journal of the Medical Sciences·Troy D Schmidt, Kevin M McGrath
Sep 18, 2002·The Journal of Pharmacology and Experimental Therapeutics·Giuseppe MolinaroAlbert Adam
Oct 31, 2002·Nature Reviews. Drug Discovery·Mohammad Amin ZamanDavid A Calhoun
May 1, 1996·Pharmacoepidemiology and Drug Safety·D G BurkhartS Weiss
Aug 11, 2004·Chest·Damanpaul SondhiGanesan Murali
Jul 27, 2005·Archives of Internal Medicine·John B KostisElliott Levy
Jan 18, 2007·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Baiju MaldePaul A Greenberger
Jan 2, 2008·Annals of Emergency Medicine·Michael Mohseni, Mark D Lopez
Mar 8, 2008·The Journal of Emergency Medicine·Matthew T Jordan, Darien Cohen
May 3, 2008·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Aleena BanerjiCarlos A Camargo
Nov 14, 2012·Archives of Internal Medicine·Sengwee TohSean Hennessy
Dec 20, 2013·JAMA : the Journal of the American Medical Association·Paul A JamesEduardo Ortiz
Nov 13, 2015·Medicine·Nicolas JavaudOlivier Fain
Dec 4, 2016·The Journal of Allergy and Clinical Immunology·Brittany T StrakaNancy J Brown
Apr 6, 2017·The Journal of Allergy and Clinical Immunology. in Practice·Aleena BanerjiLi Zhou
May 30, 2017·The Journal of Allergy and Clinical Immunology. in Practice·Richard SinertUNKNOWN CAMEO study group