Propranolol-induced angioedema in a patient with chronic hepatitis C virus infection

Abstract

A case of angioedema secondary to propranolol therapy in a patient with chronic hepatitis C virus (HCV) infection is reported. A 54-year-old Caucasian woman with chronic HCV infection started treatment with ribavirin and peginterferon alfa-2a. Four months later, oral propranolol hydrochloride 20 mg three times daily was initiated due to an episode of paroxysmal supraventricular tachycardia (PSVT). One month later, the patient developed a diffuse pruritic rash. Hydroxyzine and loratadine were prescribed for several days to treat the rash. Three weeks later, she arrived at the emergency department with generalized edema and a severe pruritic erythematous swelling that affected the face, forearms, hands, and lower extremities. The patient was diagnosed with angioedema. Blood tests revealed an increased eosinophil count (910 cells/microL), elevated aspartate transaminase and alanine transaminase concentrations (109 and 104 IU/L, respectively), and a high HCV RNA load (1,450,000 IU). Peginterferon alfa-2a, ribavirin, and propranolol were discontinued. A few days later, the edema and cutaneous lesions disappeared. Six months after the resolution of the angioedema, the patient was seen again in the emergency department because of another episode of PSVT. Oral propranolol 20 mg twice daily was reintroduced to control the tachycardia. Two days later, a similar episode of diffuse edematous swelling developed. At that time, the only drug she was taking was propranolol. Propranolol was discontinued, and the patient's symptoms spontaneously resolved. A 54-year-old Caucasian woman with chronic HCV infection developed propranolol-induced angioedema.