ACE inhibitor angioedema - a very late presentation.

Area of Science:

• Cardiology
• Pharmacology
• Emergency Medicine

Background:

• Hypertension management is crucial for cardiovascular health.
• Long-term use of angiotensin-converting enzyme inhibitors (ACEIs) like enalapril is common.
• Angioedema is a known, albeit rare, adverse effect of ACEIs.

Observation:

• A 77-year-old male with a 23-year history of enalapril use presented with acute onset of tongue swelling.
• Symptoms rapidly progressed to include dysarthria and dyspnea.
• No rash or recent non-steroidal anti-inflammatory drug (NSAID) use was reported.

Findings:

• The patient's presentation was consistent with drug-induced angioedema.
• Enalapril, an ACEI, was identified as the likely causative agent despite long-term use.
• The absence of rash and NSAID use helps differentiate from other causes of angioedema.

Implications:

• This case underscores the potential for delayed-onset angioedema from ACEIs.
• Clinicians should maintain a high index of suspicion for medication side effects in acute swelling presentations.
• Discontinuation of the offending ACEI is critical for managing and preventing recurrence of angioedema.