Angio-oedema associated with colistin.

Area of Science:

• Pharmacology
• Nephrology
• Immunology

Background:

• Type 1 diabetes mellitus (T1DM) management often involves broad-spectrum antibiotics.
• Colistin is a potent antibiotic used for multidrug-resistant Gram-negative infections.
• Angio-oedema is a rare but serious adverse drug reaction.

Observation:

• A 50-year-old female patient with T1DM developed angio-oedema.
• The angio-oedema onset and resolution were temporally linked to colistin administration and discontinuation.
• Other potential causes for angio-oedema were reasonably excluded.

Findings:

• Colistin use was identified as a probable cause of angio-oedema.
• Pseudoallergy is a potential mechanism for this adverse reaction.
• Hereditary angio-oedema types 2 or 3, renal impairment, and enalapril use were considered contributing factors.

Implications:

• This case highlights the importance of considering antibiotic-induced angio-oedema, even with rare agents like colistin.
• Clinicians should be vigilant for angio-oedema in patients with T1DM, renal impairment, or those on ACE inhibitors like enalapril.
• Further investigation into pseudoallergy mechanisms in antibiotic-induced angio-oedema is warranted.