A case report on ambrisentan-induced angioedema

Abstract

Ambrisentan is a selective type A endothelin receptor antagonist used to treat primary pulmonary arterial hypertension (PAH). A 52-year-old female was admitted to the emergency department with presenting symptoms of submandibular swelling and worsening dyspnea. The patient has a history of PAH on treatment. She was previously on sildenafil. All her blood parameters except renal function tests (blood urea, creatinine, potassium, and sodium) were normal during hospitalization for the management of PAH. Some months after treatment with sildenafil, she was switched to Ambrisentan by her consultant. ECG showed severe PAH (80 mmHg), mild right ventricle dysfunction, no regional wall motion abnormalities, and good left ventricle systolic function. She was diagnosed as cor pulmonale. She was dehydrated with reduced skin turgor. USG abdomen revealed bilateral renal parenchymal disease. She also complained of a puffy reddish discoloration of the skin along with angioedema. After ruling out the possibility of other factors contributing to angioedema, Ambrisentan was most likely related and was not excluded. Ambrisentan was, therefore, discontinued and replaced with tadalafil. She was seen on an outpatient basis and was symptomatically better. Health education was provided on the safe use of drugs. Through this report, we bring your attention to the possibility of such events with Ambrisentan, and cannot be neglected.