Reactions 1408 - 30 Jun 2012

STrandolapril

Angioedema in an elderly patient: case reportA 78-year-old woman developed angioedema while

receiving trandolapril. She later died.The woman presented to a general practitioner with a

swollen tongue and tingling sensation in her oral mucosaand lips. A resident of a psychiatric hostel, she had amedical history that included hypertension, bipolaraffective disorder and chronic renal impairment. She haddeveloped an episode of tongue swelling 6 months earlierthat had spontaneously resolved. Her medications includedtrandolapril 4 mg/day for the past 4 years [route not stated].After an unremarkable examination, she was reassured andreturned to the hostel. Six hours later, she presented withdifficulty swallowing and a markedly swollen tongue thatwas protruding from her mouth. Chest auscultationdetected turbulent sounds from the pharynx.

The woman received hydrocortisone and promethazine,and was transferred to an emergency department. Uponarrival, her posterior pharynx was completely obscured byher large protruding tongue. Bilateral submandibularoedema was also observed. She received epinephrine[adrenaline], hydrocortisone and ranitidine, and underwenturgent fibre-optic nasotracheal intubation. She was thenmanaged in an ICU under sedation. Cervical spine x-rayrevealed complete obliteration of her oropharynx by thetongue. Her tongue oedema peaked on hospital day 2, andhad almost resolved by day 6. By this time, however, shehad developed ventilator-associated pneumonia, andrequired haemodialysis for acute renal dysfunction. Sheexperienced acute coronary syndrome on day 8, followedby a pulmonary haemorrhage. After consulting her family,she received palliative care, and died on day 9 afterextubation [cause of death not stated].

Author comment: "To the authors’ knowledge, the casepresented here is the first documented fatality with [ACEinhibitor] associated angioedema caused by trandolapril."Andrew N, et al. ACEI associated angioedema - a case study and review.[Review]. Australian Family Physician 40: 985-8, No. 12, Dec 2011 -Australia 803072684

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Reactions 30 Jun 2012 No. 14080114-9954/10/1408-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved