A vivid example of angioedema

Abstract

Case reportA 68-year-old hypertensive woman, who had been using25 mg of carvedilol daily for the past 5 years, woke up withedema of the tongue and dyspnea. At the admission to therural hospital, 5 mg of hydrocortisone and 5 mg of dex-chlorpheniramine were given intravenously, and the patientwas sent to our department. It was learned from relatives ofthe patient that she had been given sublingual captopril inanother hospital where she had been treated the day beforefor hypertension. Additionally, it was reported that thepatient hadalsosufferedfromtongueedema intheprioryearafter using the same medication, sublingual captopril. Onphysical examination, she was alert, with vital signs: bloodpressure 130/80 mmHg, pulse rate 94 beats per minute,respiration rate 14 breathes per minute (Fig. 1). Inspiratorystridor was heard on auscultation, and the patient was notable to speak. She was breathing supplemental oxygen,placed on a cardiac monitor, and intravenous lines wereestablished. Therapy was commenced with 0.3 mg of a1:10,000 epinephrine subcutaneously, 40 mg methylpred-nisolone, 50 mg diphenhydramine administered intra-venously. Over the following 10 min, subcutaneous 0.3 mgof a 1:10,000 epinephrine was repeated a single time. Thetongue of the patient decreased in size and she became ableto speak. The patient stayed in the observation unit for 24 hand was discharged without any further problems.DiscussionAngiotensin-converting enzyme (ACE) inhibitors are fre-quently used in the treatment of hypertension. Side effectprofiles vary from minor allergic reactions to anaphylactic