Angioedema, ACE inhibitor and COVID-19

Area of Science:

• Cardiology
• Infectious Diseases
• Pharmacology

Background:

• The renin-angiotensin system (RAS) regulates blood pressure.
• Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed for hypertension.
• ACE2 receptors are involved in the RAS and are targeted by SARS-CoV-2.

Observation:

• A 57-year-old male patient presented with angioedema (tongue swelling, shortness of breath, difficulty speaking).
• The patient was unknowingly infected with SARS-CoV-2 (COVID-19).
• The patient had been taking benazepril, an ACE inhibitor, for 4 months prior to presentation.

Findings:

• This case suggests a potential interaction between SARS-CoV-2 infection and ACE inhibitor use, leading to angioedema.
• The virus's binding to ACE2 receptors may disrupt the normal counterbalance in the RAS.
• Possible mechanisms for SARS-CoV-2 potentiation of angioedema are discussed.

Implications:

• Clinicians should consider COVID-19 in patients on ACE inhibitors presenting with angioedema.
• This case underscores the need for further investigation into the safety of ACE inhibitors during SARS-CoV-2 infection.
• Understanding these interactions is crucial for managing patients with both cardiovascular conditions and COVID-19.