[Angioedema caused by C1-esterase inhibitor deficiency or ACE inhibitors?]

A 49-year-old woman was admitted to the intensive care ward with increasing shortness of breath due to a massive soft tissue swelling of the neck and face and a marked macroglossia. Similar symptoms were already observed earlier in the patient as well as her father, although such symptoms were never as dramatic as they were on this occasion. The patient was intubated bronchoscopically and treated unsuccessfully with cortisone, fresh plasma und C1-esterase inhibitor. The patient only first reported intake of an ACE inhibitor a few days after the acute episode, which was most probably the causative factor given that serum C1 and C4 complement factors were almost normal.