ACE inhibitor-related angioedema in a COVID-19 patient—a plausible contribution of the viral infection?

Kuzemczak, Michał; Kavvouras, Charalampos; Alkhalil, Mohammad; Osten, Mark

doi:10.1007/s00228-020-03082-w

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…The virus, by binding to the ACE II receptor, depletes ACE II, thereby leading to an increase in the des-Arg9-bradykinin level, an active bradykinin metabolite [14]. There have been a few case reports of angioedema occurring in patients with concomitant ACE inhibitor use and SARS-CoV-2 infection [15][16][17][18][19][20]. This case strengthens a potential interplay between these two factors in the development of angioedema.…”

Section: Discussionmentioning

confidence: 68%

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Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema in an African American Male With Coronavirus Disease 2019 (COVID-19)

Bresler,

Whelan

2024

Cureus

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Angioedema is a condition characterized by non-pitting swelling of the subcutaneous or submucosal tissues in particular the face, lips, and oral cavity. Angiotensin-converting enzyme (ACE) inhibitors are known to contribute to the development of angioedema by increasing the levels of bradykinin and its active metabolites. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is hypothesized to contribute to the development of angioedema by modifying ACE II levels and further increasing the level of bradykinin in patients taking ACE inhibitors. African Americans may be at particular risk of developing angioedema with concomitant SARS-CoV-2 infection and ACE inhibitor use. This case involves a 31-year-old African American male diagnosed with coronavirus disease 2019 (COVID-19) who developed angioedema while taking an ACE inhibitor.

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Section: Discussionmentioning

confidence: 68%

“…Management approach in previous cases consisted of cessation of the ACE inhibitor in all cases. In four cases, systemic glucocorticoids and anti-histamines were initiated [ 15 , 17 , 20 ]. In two cases, only systemic glucocorticoids were implemented [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema in an African American Male With Coronavirus Disease 2019 (COVID-19)

Bresler,

Whelan

2024

Cureus

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“…The use of ACE inhibitor medications can cause angioedema of the larynx that mimics acute epiglottitis, by increasing the levels of bradykinin ( 4 ). Because SARS-CoV-2 spike proteins binding to ACE2 receptors can cause downregulation of the ACE2 protein, SARS-CoV-2 infection can likely also lead to angioedema of the larynx, as Kuzemczak et al reported a patient who developed angioedema of the tongue after SARS-CoV-2 infection ( 5 ). To deny this possibility, the authors should be clear about whether or not this patient complained of facial swelling, macroglossia, and other characteristic of angioedema.…”

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confidence: 99%

Acute Bacterial Epiglottitis and COVID-induced Angioedema of the Larynx Are Possible Differential Diagnoses

2022

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To the Editor We read the article, "A Case of COVID-19 Presenting with Acute Epiglottitis," published by Yamada A et al. in Internal Medicine Advance Publication 0163-22 (1) with great interest. The authors carefully assessed, treated, and described this potentially life-threatening illness that can lead to complete upper airway obstruction. However, we have two major concerns about their conclusion due to a lack of details. Therefore, we would like to know the details with regard to this patient's clinical course.Epiglottitis is associated with various pathogens, including bacteria, viruses, and fungi (2). We suspected that the patient had superinfection with bacteria pathogen based on the neutrophil-dominant inflammatory reaction and susceptibility to antibiotics. Although the authors seem to interpret this case as a rare case of acute epiglottitis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, acute bacterial epiglottitis should also be considered, as COVID-19 is often asymptomatic in young people without complications, such as hypertension and diabetes mellitus (3). Our first concern that we would like the authors to address is whether or not the patient had evidence of any other respiratory viruses or bacterial organism infections, such as Influenza A, Influenza B, or Haemophilus influenzae. The reply to this point is very critical in order to clarify whether or not SARS-CoV-2 can cause acute epiglottitis and to help establish a treatment modality for acute epiglottitis caused by SARS-CoV-2 infection. Treatment with corticosteroids, antibiotics, and epinephrine inhalation, which the authors performed on this patient, is also effective for acute bacterial epiglottitis. Furthermore, if the diagnosis of this

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Ramipril

2021

Reactions Weekly

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Angioedema: case reportA 53-year-old man developed angioedema during treatment with ramipril for myocardial infarction. The man was initially admitted due to myocardial infarction, one week after being diagnosed with COVID-19. Urgent coronary angiography revealed multivessel coronary thrombosis. Subsequently, he underwent a procedure and was transferred to a COVID-19-dedicated ward. He was started on ramipril 2.5 mg/day [route not stated] along with aspirin, ticagrelor, rosuvastatin and bisoprolol. One day following discharge and 5 days after ramipril initiation, he was again admitted because of tongue swelling, which was thought to be related with ACE inhibitor-induced angioedema. He did show any rush or pruritus. He also denied having shortness of breath, nausea, or fever. Furthermore, he or his family history was negative for allergies or angioedema.The man's therapy with ramipril was replaced with telmisartan. He was treated with glucocorticosteroid, famotidine and diphenhydramine. Eventually, he was discharged in a good clinical condition. His angioedema was attributed to both ramipril and COVID-19 infection.

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ACE inhibitor-related angioedema in a COVID-19 patient—a plausible contribution of the viral infection?

Cited by 4 publications

References 5 publications

Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema in an African American Male With Coronavirus Disease 2019 (COVID-19)

Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema in an African American Male With Coronavirus Disease 2019 (COVID-19)

Acute Bacterial Epiglottitis and COVID-induced Angioedema of the Larynx Are Possible Differential Diagnoses

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