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Fatal angioedema associated with captopril.
1Department of Pathology, Bowman Gray School of Medicine, Winston-Salem, NC.
Journal of Forensic Sciences
|September 1, 1992
Summary
Angiotensin-converting enzyme (ACE) inhibitor therapy can cause rare but fatal obstructive angioedema. This case highlights the rapid progression and potential for misdiagnosis of this serious adverse drug reaction.
Area of Science:
- Pharmacology
- Emergency Medicine
- Forensic Pathology
Background:
- Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for hypertension.
- Angioedema is a known, albeit rare, side effect of ACE inhibitor therapy.
- Early recognition is crucial due to the potential for rapid airway compromise.
Observation:
- A 70-year-old hypertensive male on captopril developed severe laryngeal and glossal edema over 3.5 hours.
- Airway obstruction occurred rapidly, leading to unsuccessful intubation.
- A subsequent tracheostomy was performed too late to prevent mortality.
Findings:
- The patient experienced obstructive angioedema, a life-threatening adverse drug reaction.
- The rapid progression and sudden onset mimicked an allergic reaction, complicating diagnosis.
- Autopsy was performed due to the unusual and sudden nature of the death.
Implications:
- This case underscores the critical need for heightened awareness of ACE inhibitor-induced angioedema among clinicians.
- Forensic medical professionals should consider angioedema in cases of sudden, unexplained airway obstruction.
- Distinguishing angioedema from anaphylaxis is vital for appropriate emergency management and patient outcomes.