Otolaryngology Case Reports (Mar 2022)
Unrecognized recurrent perioperative angioedema requiring intubation in a patient taking long-term angiotensin-converting enzyme inhibitor therapy
Abstract
Introduction: Angiotensin converting enzyme (ACE) inhibitors are a leading class of antihypertensives, which are a well-documented cause of angioedema related to prescription drugs. The purpose of this report is to highlight the importance of recognition and intervention of perioperative angioedema in patients taking ACE inhibitors with discussion of risk factors of ACE inhibitor-associated angioedema so that physicians may better identify patients at risk. Methods: This is a case report of a 44 year old African American female with an undisclosed remote history of mild perioperative ACE inhibitor associated angioedema who presented with a long history of tonsil stones and underwent elective tonsillectomy complicated by worsening angioedema requiring intubation. Results: Review of the literature indicates patients who are age >65, female, and African American race and those with a past medical history of ectopic disease such as drug rashes, NSAID allergies, seasonal allergies, asthma and/or eczema are at increased risk of ACE inhibitor associated angioedema. Diabetic patients taking DPP-IV inhibitors concomitantly with ACE inhibitors are also at increased risk for angioedema events. Conclusion: Understanding of patient associated risk factors for development of ACE inhibitor associated angioedema and careful consideration of these risk factors is necessary to prevent undue complications. Physicians must remain vigilant in screening for past swelling episodes in patients taking ACE inhibitors.
