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Simultaneous mucosal and small bowel angioedema due to captopril
1Department of Internal Medicine, University of Louisville and Department of Veterans Affairs, KY 40292, USA.
Southern Medical Journal
|November 21, 1998
Summary
Angiotensin-converting enzyme inhibitors (ACEIs) can cause rare cases of bowel angioedema. This case highlights simultaneous orofacial and small bowel angioedema from captopril, emphasizing the need for clinical vigilance.
Area of Science:
- Pharmacology
- Gastroenterology
- Internal Medicine
Background:
- Angiotensin-converting enzyme inhibitors (ACEIs) are frequently associated with orofacial angioedema.
- Gastrointestinal angioedema induced by ACEIs is less commonly recognized.
Observation:
- A 61-year-old male on long-term captopril therapy presented with acute onset orofacial swelling.
- Simultaneously, he experienced nausea, vomiting, abdominal pain, and diarrhea, indicative of bowel distress.
Findings:
- The patient exhibited orofacial edema and abdominal tenderness.
- Abdominal X-ray revealed an ileus pattern; C1-esterase inhibitor levels were normal.
- Symptoms resolved within 24 hours after discontinuing captopril, confirming drug-induced angioedema.
Implications:
- This case underscores the potential for ACEIs to cause simultaneous orofacial and small bowel angioedema.
- Clinicians should maintain a high index of suspicion for gastrointestinal involvement in patients on ACEIs presenting with abdominal symptoms.
- Vigilance for ACEI-induced angioedema, including its less common gastrointestinal manifestations, is crucial for timely diagnosis and management.
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