A slow and dangerous swelling of the tongue and the face

Abstract

A 91-year-old man presented at our emergency room complaining of sialorrhea and facial edema, especially around his lips and palpebral region. The symptoms started in the morning and got worse over two hours. He had a history of hypertension and hypokinetic ischemic cardiomyopathy treated with ramipril, doxazosin, aspirin, furosemide, amiodarone, ranolazine, atorvastatin, and pantoprazole. He referred an allergy to clopidogrel. He did not introduce any novel medications or foods. His vital signs were BP 150/70, HR 57 bpm, sO2 97% in room ambient, RR 18/min, and BT 36.4 °C. He presented a severe edema of the tongue with tirage and cornage. He was immediately treated IV with hydrocortisone 1 g chlorpheniramine maleate 10 mg, and icatibant 30 mg SC and he was intubated through the nose.

Keywords

• Angioedema
• angiotensin‐converting enzyme inhibitor
• anaphylaxis
• Icatibant
• bradykinin