High-Dose Simvastatin as a Potential Trigger for Angioedema: A Case Report for Broader Diagnostic Consideration

Angioedema (AE) is a potentially life-threatening condition involving swelling under the skin. The most common pharmacologic cause of this reaction is angiotensin-converting enzyme (ACE) inhibitor (ACEi) therapy, but other medications may contribute to the development of AE. This case describes a 68-year-old male who presented to the emergency department with tongue and lip swelling and was diagnosed with AE, initially attributed to lisinopril use. However, outpatient follow-up revealed that the only recent medication change was an inadvertent supratherapeutic 60 mg daily dose of simvastatin. Furthermore, the patient was found to have a medical history of AE secondary to atorvastatin use 13 years prior. Based on his history, the ACEi was discontinued, and the statin dose was reduced with symptom resolution. The patient's clinical course adds to the limited literature on statin-induced AE, particularly in the setting of concurrent ACEi use. It also underscores the importance of thorough medication reconciliation and avoiding premature diagnoses of the most common etiology.