Delayed presentation of ACE inhibitor-induced angio-oedema

We report two probable cases of delayed presentation of ACE inhibitor (ACEi)-induced angio-oedema. The first patient was on ACEi for more than 10 years while the second one was on it for 7 years. Both the patients presented with initial unilateral swelling of the tongue which progressed further to involve the soft tissues of the oropharynx, head and neck leading to a compromised airway needing awake fibreoptic intubation and were managed successfully in the intensive care unit (ICU). C1 esterase inhibitor and mast cell tryptase level was normal for both patients. Both were treated with intravenous antihistamines and corticosteroids in the ICU. Both patients were successfully extubated within 72 h and transferred to a medical ward. Age above 65 years, atopy and non-steroidal anti-inflammatory drug use may have been the predisposing factors. Both patients made a full recovery with no complications and the ACEi was ceased.