Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema Following Posterior Reversible Encephalopathy Syndrome in a Child: A Case Report

Abstract

Angioedema is a rare but potentially lethal side effect of angiotensin-converting enzyme inhibitors (ACEIs). Most ACEI-induced angioedema (ACEI-AE) cases have been reported in adults, with few reports of cases in children. Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder that presents with acute onset of symptoms, including headache, vomiting, visual disturbances, and seizures. We report the case of a patient who developed ACEI-AE after developing PRES during the treatment of steroid-resistant nephrotic syndrome. ACEI-AE is very rare, especially in children, but can be life-threatening if swelling of the tongue or the throat blocks the airway. Whenever ACEIs are used, even in children, clinicians should be aware of the possibility of the occurrence of ACEI-AE, particularly when accompanied by dry cough. Moreover, bradykinin may be associated with PRES onset in patients with ACEI-AE and may be a risk factor for PRES.

Bradykinin-Mediated Angioedema Induced by Commonly Used Cardiovascular Drugs

“…It must be assumed that swellings in the head and neck region (Figure 1) are often not recognized as ACE-inhibitor-induced angioedema and thus discontinuation of the ACE inhibitor (see Section 6.1) is not considered. Of note, ACE-inhibitor-induced angioedema has also been described to occur in a small child [59]. The clinical course of ACE-inhibitor-induced angioedema cannot be foreseen.…”