Angioedema, ACE inhibitor and COVID-19

Abstract

SARS-CoV-2, the virus responsible for COVID-19, binds to the ACE2 receptors. ACE2 is thought to counterbalance ACE in the renin-angiotensin system. While presently it is advised that patients should continue to use ACE inhibitors or angiotensin receptor blockers, questions still remain as to whether adverse effects are potentiated by the virus. Here, we report a case of a 57-year-old man, unknowingly with COVID-19, who presented to the emergency department with tongue swelling, shortness of breath and difficulty in speaking following 4 months taking benazepril, an ACE inhibitor. Finally, we also describe possible pathways that exist for SARS-CoV-2 to interact with the mechanism behind angioedema.

Angioedema and acute urticaria in a patient with COVID 19 pneumonia: Favipiravir side effect or COVID-19 cutaneous manifestation

“…When the medical literature is examined, a variety of dermatologic eruptions thought to be related to COVID-19 has been reported, but angioedema has rarely been reported [5][6][7][8][9][10] . Najafzadeh et al 8 was reported similar case as and suggested that angioedemaas possible early diagnostic indicator of COVID-19 infection.…”

Reply to Chan and Majluf-Cruz: Is the Angioedema Associated with COVID-19 a Real Entity, a Mimic, or Both?

“…At this time, we have noted several publications associating facial, tongue, eye, and lips swelling with COVID-19; however, none of them made a definitive association with race ( 5 – 8 ).…”

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

“…Considering the fact that late-onset angioedema on ACE inhibitors is rarely observed, the cited case report supports the notion on the role of COVID-19 as a contributing factor to angioedema. Tongue swelling in a patient taking benazepril for 4 months, unknowingly with COVID-19, has been also recently reported [ 5 ].…”

“…On the other hand, it is known that ACE-2 receptor is essential for COVID-19 invasion. Binding the virus to the receptor leads to downregulation of ACE-2 which is one of the enzymes responsible for bradykinin breakdown [ 1 , 4 , 5 ]. Therefore, in the presented case, both ramipril and COVID-19 infection could have contributed to the angioedema by increasing levels of bradykinin.…”

“…The presented case report suggests that COVID-19 infection may increase the risk of developing angioedema in patients on ACE-I which should be taken into account by healthcare professionals when planning a guideline-based treatment [ 4 , 5 ]. Considering the fact that ACE inhibitors are one of the most widely used medications for hypertension and heart failure, clinicians should bear in mind the potentially increased risk of angioedema in the context of COVID-19.…”