Isolated intestinal type angioedema due to ACE‐inhibitor therapy

Abstract

Key Clinical MessageA 42‐year‐old woman presents with abdominal pain after taking her first dose of lisinopril. Visceral angioedema was diagnosed based on clinical suspicion and abdominal computed tomography (CT). Awareness of this rare side effect of a common medication is key to avoid delays in diagnosis and unnecessary procedures.

An unusual presentation of ACE inhibitor-induced visceral angioedema

“…Interestingly, this study found some key characteristics of those with ACEi-induced visceral angioedema, namely women were more affected than men (85%), African Americans were more likely to be affected than other races, and lisinopril (56%) was most often the culprit ACEi 5. The average age of individuals affected was 49.5 years 5. Reported symptoms at presentation included abdominal pain in all patients, 77% with emesis and 47% with diarrhoea 5…”

“…In a review by Palmquist and Mathews, the authors found 34 individual reports of ACEi-induced visceral angioedema 5. Interestingly, this study found some key characteristics of those with ACEi-induced visceral angioedema, namely women were more affected than men (85%), African Americans were more likely to be affected than other races, and lisinopril (56%) was most often the culprit ACEi 5. The average age of individuals affected was 49.5 years 5.…”

Angioedema of the small bowel caused by lisinopril

“…ACEi-induced angioedema of the small intestine is a rare adverse reaction1; yet, it is important to recognise this side effect as the drug is one of the most commonly prescribed medications in the country. As the symptoms of visceral angioedema may mimic other diseases, it may lead to misdiagnosis or unnecessary work up and procedures.…”

“…Onset of symptoms is usually within days to weeks of initiation of the drug 2. Patients commonly present with abdominal pain, nausea, vomiting and diarrhoea, and it occurs more frequently in females than males 1. CT of the abdomen is known to show segmental oedema of the small bowel, mild dilatation, straightening and ascites among patients with angioedema 3.…”

The role of bradykinin receptor type 2 in spontaneous extravasation in mice skin: implications for non‐allergic angio‐oedema

“…Furthermore, the new drug combination sacubitril/valsartan (McMurray et al ., ) has the potential to induce non‐allergic angio‐oedema (Bas et al ., ) and a life‐threatening case has been reported recently (Raheja et al ., ). Although intestinal manifestations of non‐allergic angio‐oedema caused by ACEi have been described (Palmquist and Mathews, ), almost all cases induced by RAAS blockers are localized to the upper aero‐digestive tract. Such swellings often require emergency treatment, and fatal cases have been reported (Ulmer and Garvey, ; Oike et al ., ; Dean et al ., ; Atalay et al ., ).…”