Acute Angioedema Associated with Long-Term Benazepril Therapy

Abstract

Objective: To report a case of acute angioedema associated with long-term use of benazepril in an elderly patient. Case Summary: A 78-year-old white woman with no past history of angioedema presented to the emergency department in respiratory distress. The patient failed to improve after receiving intravenous methylprednisolone, diphenhydramine, and famotidine. Due to pending airway compromise, the patient required emergency tracheostomy. Based on her presentation and medical history, we attributed the angioedema to long-term benazepril use. Discussion: Angiotensin-Converting enzyme (ACE) inhibitors are known to be associated with angioedema. Most cases of angioedema occur within the first week of therapy. The association of acute onset of angioedema early in the course of ACE inhibitor therapy is well described in published reports. However, angioedema associated with long-term ACE inhibitor therapy has rarely been reported. Conclusions: ACE inhibitor-induced angioedema occurring late in therapy is not well understood and has been infrequently reported in published articles. Aggressive intervention is often needed in severe cases of angioedema, which may compromise airway integrity.