Potentially lethal ACE-inhibitor-induced angioedema in a child

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Published on: September 28, 2015

Esraa Bukhari1, Osama Y Safdar2, Mohammed Shalaby2

  • 1Department of Pediatrics, King Abdulaziz University Hospital Jeddah, Kingdom of Saudi Arabia.

Clinical Case Reports
|July 18, 2015
PubMed

Insights

Angiotensin-converting enzyme inhibitor-induced angioedema can cause sudden tongue swelling in children with kidney disease. Promptly stopping the medication, like captopril, can resolve symptoms and prevent airway obstruction.

Area of Science:

  • Pediatric Nephrology
  • Pharmacology
  • Emergency Medicine

Background:

  • End-stage kidney disease (ESKD) increases susceptibility to certain drug side effects.
  • Angiotensin-converting enzyme inhibitors (ACEIs) are commonly used in patients with ESKD.
  • ACEIs can lead to angioedema through bradykinin accumulation.

Observation:

  • A 9-year-old female with ESKD presented with acute onset tongue swelling.
  • The patient was taking captopril, an ACEI.
  • Sudden tongue swelling is a critical symptom requiring immediate attention.

Findings:

  • The patient was diagnosed with ACE inhibitor-induced angioedema.
  • Bradykinin accumulation was identified as the underlying mechanism.
  • Discontinuation of captopril led to rapid resolution of symptoms.

Implications:

  • Early recognition and diagnosis of ACE inhibitor-induced angioedema are crucial in pediatric patients with kidney disease.
  • Promptly withdrawing the offending ACEI can prevent severe upper airway compromise.
  • This case highlights the importance of medication review in patients with ESKD presenting with unusual swelling.

Keywords:
Adverse reactionangioedemaangiotensinogen-converting enzyme inhibitorcaptopril

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