Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

25 May 2017 : Case report  Germany

Drug-Induced Inhibition of Angiotensin Converting Enzyme and Dipeptidyl Peptidase 4 Results in Nearly Therapy Resistant Bradykinin Induced Angioedema: A Case Report

Unusual clinical course, Diagnostic / therapeutic accidents, Management of emergency care, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)

Janina Hahn1EF*, Susanne Trainotti1F, Thomas K. Hoffmann1A, Jens Greve1AF

DOI: 10.12659/AJCR.901960

Am J Case Rep 2017; 18:576-579

Abstract

BACKGROUND: Bradykinin is an underestimated mediator of angioedema. One subgroup of bradykinin induced angioedema is angioedema triggered by treatment with angiotensin converting enzyme (ACE) inhibitors. Due to its localization in the head and neck region and its unpredictable course, it is a possibly life-threatening condition. There is not an officially approved treatment for ACE inhibitor induced angioedema.

CASE REPORT: We present a case of an 83-year-old woman, who presented to our ENT department because of acute swelling of the tongue. On admission, there was no pharyngeal or laryngeal edema and no dyspnea. Treatment with glucocorticoids and antihistamines had no response. The patient had ramipril as regular medication, so we assumed ACE inhibitor induced angioedema and treated consequently with C1-inhibitor (human) 1,500 IU. Nevertheless, swelling was progressive and required intubation. Even after the second specific treatment with icatibant, her angioedema subsided extremely slowly. The patient also had regular treatment with saxagliptin, a dipeptidyl peptidase 4 inhibitor, so we assumed that the simultaneous inhibition of two bradykinin degrading enzymes led to a treatment-refractory course of angioedema.

CONCLUSIONS: General awareness for bradykinin induced angioedema due to regular medication is limited. Our case demonstrated the importance of improving awareness and knowledge about this side effect. We need a better understanding of the pathomechanism to aid in more precise clinical diagnosis. Securing the patient’s airway as well as administration of an officially approved therapy is of utmost importance. As the number of patients simultaneously treated with antihypertensive and antidiabetic drugs is likely to increase, the incidence of bradykinin mediated drug induced angioedema is likely to increase as well.

Keywords: angioedema, bradykinin, Cholinesterase Inhibitors, Dipeptidyl-Peptidase IV Inhibitors, Drug-Related Side Effects and Adverse Reactions

Add Comment 0 Comments

In Press

Case report  Grenada

Extragastrointestinal Stromal Tumor Mimicking Appendicitis: A Case Study

Am J Case Rep In Press; DOI: 10.12659/AJCR.944665  

Case report  China

Vision-Threatening Complications of Juxtapapillary Retinal Capillary Hemangioma: A Case of Retinal Artery O...

Am J Case Rep In Press; DOI: 10.12659/AJCR.946514  

Case report  USA

Treatment of Post-COVID-19 Pulmonary Aspergilloma: Insights from a Clinical Case

Am J Case Rep In Press; DOI: 10.12659/AJCR.946456  

Case report  China

Rare Presentation of Middle Ear Neuroendocrine Tumor: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.945602  

Most Viewed Current Articles

21 Jun 2024 : Case report  China (mainland) 90,010

Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...

DOI :10.12659/AJCR.944371

Am J Case Rep 2024; 25:e944371

0:00

07 Mar 2024 : Case report  USA 50,284

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133

0:00

20 Nov 2023 : Case report  Saudi Arabia 25,908

Azithromycin Treatment for Acne Vulgaris: A Case Report on the Risk of Clostridioides difficile Infection

DOI :10.12659/AJCR.941424

Am J Case Rep 2023; 24:e941424

0:00

18 Feb 2024 : Case report  Japan 22,715

A Case of Thoracic Empyema Caused by Actinomyces naeslundii

DOI :10.12659/AJCR.943030

Am J Case Rep 2024; 25:e943030

0:00

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923