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Matsuhisa Y, Kenzaka T, Shimizu H, Hirose H, Gotoh T. Recurrence of unilateral angioedema of the tongue: A case report. World J Clin Cases 2023; 11:6603-6612. [PMID: 37900225 PMCID: PMC10601000 DOI: 10.12998/wjcc.v11.i27.6603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Angioedema is a disorder characterized by edema of the face, lips, tongue, and extremities due to increased vascular permeability. Angioedema of the tongue usually occurs bilaterally, and the incidence of unilateral angioedema of the tongue is rare. This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor. CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril. She was diagnosed with angioedema due to unilateral swelling of the tongue. No airway obstruction was observed, and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously. Although lisinopril was discontinued, unilateral angioedema of the tongue continued to recur every 2-5 mo, with the symptoms improving following the administration of prednisolone and an antihistamine. Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema. CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.
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Affiliation(s)
- Yuki Matsuhisa
- Department of General Medicine, Center for Community Medicine in North-Western Gifu Prefecture National Health Insurance Shirotori Hospital, Gujo 501-5122, Japan
- Department of Pediatrics, Center for Community Medicine in North-Western Gifu Prefecture National Health Insurance Shirotori Hospital, Gujo 501-5122, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 652-0032, Japan
| | - Hironori Shimizu
- Department of General Medicine, Center for Community Medicine in North-Western Gifu Prefecture National Health Insurance Shirotori Hospital, Gujo 501-5122, Japan
| | - Hideo Hirose
- Department of General Medicine, Center for Community Medicine in North-Western Gifu Prefecture National Health Insurance Shirotori Hospital, Gujo 501-5122, Japan
| | - Tadao Gotoh
- Department of General Medicine, Center for Community Medicine in North-Western Gifu Prefecture National Health Insurance Shirotori Hospital, Gujo 501-5122, Japan
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Russo T, Kouyoumjian S, Fargaly H. Angioedema: A Possible Complication of Amlodipine Use. Cureus 2023; 15:e42202. [PMID: 37484793 PMCID: PMC10358783 DOI: 10.7759/cureus.42202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
Angioedema is a documented but uncommon adverse effect of dihydropyridine calcium channel blockers such as amlodipine. We present the case of a 38-year-old man who presented to the emergency department (ED) with severe swelling of his upper lip that had begun earlier in the day. His medical history was notable for hypertension treated with amlodipine; his only other medication was a multivitamin. The patient denied any known drug allergies, new foods, insect bites, recent travel, or sick contacts. Physical examination showed hypertension and massive edema isolated to the upper lip; it was otherwise unremarkable. Laboratory results showed no abnormalities aside from a slight normocytic anemia. The patient was diagnosed with angioedema, with amlodipine suspected as the cause. Amlodipine was discontinued and treatment was initiated with IV glucocorticoids and diphenhydramine. The swelling improved steadily over the next 36 hours and the patient was discharged on hospital day 3.
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Affiliation(s)
- Thomas Russo
- Emergency Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Sarkis Kouyoumjian
- Emergency Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Hithem Fargaly
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
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Hammad M, Adam N, Sarfaraz K, Adam M, Mansoor N. A Case Report of Lifesaving Intravenous Bolus Epinephrine Administration in a Case of Severe Refractory Anaphylactic Shock. Cureus 2022; 14:e28249. [PMID: 36158400 PMCID: PMC9490436 DOI: 10.7759/cureus.28249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Anaphylaxis is a life-threatening response to various types of allergens. Early recognition and management are crucial for reducing mortality. This case report highlights a 31-year-old male with a background of hypertension who presented to the emergency department with nausea, vomiting, right flank pain, headache, and elevated blood pressure (BP) of 212/134 mmHg. The patient was started on stat captopril 12.5 mg tablet and stat amlodipine 5 mg tablet for his high BP and stat diclofenac 75 mg (1 mg/kg) intramuscular (IM) for his flank pain. Two minutes later the patient started developing swelling of his mucosal membranes with no urticaria or rashes and his BP suddenly dropped and was unrecordable. First-line management was immediately initiated including the administration of two standard adult doses of IM epinephrine of 500 mcg each with a 5-minute interval. The BP remained undetectable; accordingly, a third IM epinephrine dose of 500 mcg was administered along with an intravenous (IV) epinephrine drip initiated at a rate of 4 mcg/min. The BP became 60/40 mmHg but kept dropping, thus an IV epinephrine bolus of 300 mcg (4 mcg/kg) was given along with the ongoing IV epinephrine drip. BP increased to 126/75 mmHg. While on the IV epinephrine drip the BP dropped again to 88/59 mmHg, a second IV epinephrine bolus of 200 mcg (2.6 mcg/kg) was given and the BP became 140/90 mmHg and recovery was achieved. Emergency cases require immediate recognition and intervention. Currently, IM epinephrine is the primary treatment for anaphylaxis. We hope our case report contributes to the database on severe refractory anaphylaxis by discussing a successful case where IV bolus epinephrine was used to prevent imminent cardiovascular collapse. Highlighting the need for appropriate escalation of management given the availability of physicians with expertise.
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Minami C, Araki R, Hamamoto T, Yamada H. [Orolingual Angioedema after Recombinant Tissue Plasminogen Activator Treatment in Acute Cardiogenic Cerebral Embolism Patient Using Olmesartan: A Case Report]. YAKUGAKU ZASSHI 2022; 142:85-89. [PMID: 34980751 DOI: 10.1248/yakushi.21-00136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recombinant tissue plasminogen activator (rt-PA), which is used to treat acute cerebral infarction, may cause angioedema immediately after administration particularly in patients who are taking angiotensin-converting enzyme (ACE) inhibitors. On the other hand, unlike ACE inhibitors, angiotensin II receptor blockers (ARBs) do not act directly on bradykinin, and are therefore considered an alternative to ACE inhibitors in patients with bradykinin-related side effects. We report a case of orolingual angioedema in an 82-year-old male patient who is taking ARB, which occurred after rt-PA administration for acute cerebral infarction. The patient, who has been on medications for hypertension including ARB (olmesartan 40 mg/day) and for hyperuricemia, was transported to our hospital with the chief complaint of right conjugate deviation of the eyes and left hemiplegia. Head magnetic resonance imaging revealed cerebral infarction in the right mesencephalic artery area including the insular cortex. He was diagnosed with cardiogenic cerebral embolism, and rt-PA administration was started 4 h after onset. The patient developed eyelid edema 2.5 h after the start of administration, and orolingual angioedema and breathing difficulty 15.5 h after. The patient was treated with methylprednisolone, d-chlorpheniramine maleate, and famotidine, and the symptoms improved gradually in 1.5 h. We should pay attention to the occurrence of orolingual angioedema not only at the beginning of rt-PA administration but also for a long time thereafter when it is used in patients taking ARBs.
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Affiliation(s)
- Chisa Minami
- Department of Pharmacy, Yamato Municipal Hospital
| | | | - Tomoyuki Hamamoto
- Laboratory of Applied Therapeutics, Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University
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Zhang J, Yao MY, Zhang GR, Chen XR, Liu Q, Guo Y, Jia XW. Effects of different enantiomers of amlodipine on lipid profiles and vasomotor factors in atherosclerotic rabbits. Open Life Sci 2021; 16:899-908. [PMID: 34553070 PMCID: PMC8422977 DOI: 10.1515/biol-2021-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
This research aimed to describe the functions of vascular endothelial cells (VECs) in protecting target organs and the anti-atherosclerotic effects of different enantiomers of amlodipine on a rabbit model of atherosclerosis. Thirty male New Zealand white rabbits were randomly allocated to four groups (nA = 9, nB = 7, nC = 7, and nD = 7 rabbits): rabbits in group-A (control group) were fed a high-fat diet, group-B rabbits were fed a high-fat diet plus 2.5 mg/kg/day S-amlodipine, group-C rabbits were fed a high-fat diet plus 2.5 mg/kg/day R-amlodipine, and group-D rabbits were fed a high-fat diet plus 5 mg/kg/day racemic amlodipine. Different enantiomers of amlodipine did not influence lipid profiles and serum level of eNOS in the rabbit atherosclerosis model but decreased ET-1 expression to some extent. The serum NO and iNOS levels in the drug intervention groups were significantly reduced. No significant differences in the rabbits' body weights were observed. At the 4th and 8th weeks, the serum lipid profiles significantly increased in high cholesterol diet groups. The serum ET-1 level was significantly increased in each group of rabbits at the 8th week. Both S-amlodipine and R-amlodipine may protect the endothelium by reducing the serum ET-1 level, downregulating iNOS expression.
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Affiliation(s)
- Jing Zhang
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
| | - Ming-yan Yao
- Department of Endocrinology, Baoding No. 1 Central Hospital, Baoding, Hebei, 071000, China
| | - Guo-rui Zhang
- Department of Cardiology, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, 050000, China
| | - Xian-ru Chen
- Department of Cardiology, Affiliated Hospital of Hebei Engineering University, Handan, Hebei, 056000, China
| | - Qi Liu
- Department of Cardiology, Shijiazhuang Traditional Chinese Medicine Hospital, Shijiazhuang, Hebei, 050000, China
| | - Yifang Guo
- Cardiology Division in Geriatric Institute, Hebei Provincial People’s Hospital, Shijiazhuang, Hebei, 050000, China
| | - Xin-wei Jia
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, China
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Pall AH, Lomholt AF, von Buchwald C, Bygum A, Rasmussen ER. Clinical Features and Disease Course of Primary Angioedema Patients in a Tertiary Care Hospital. J Asthma Allergy 2020; 13:225-236. [PMID: 32764994 PMCID: PMC7373665 DOI: 10.2147/jaa.s245161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/05/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose To give a better understanding of primary AE, the clinical characteristics and the possible therapeutic approaches. Background Angioedema (AE) is a non-pitting, non-itching swelling of skin or mucosa. The symptom can become life-threatening if located in the airways. Primary (monosymptomatic) AE is a manifestation of several different diseases and the diagnosis is not always straight-forward. The aetiological and pathophysiological factors of primary AE are not completely clarified. There is a need for further investigation. Patients and Methods This was a retrospective cohort study of patients referred to an outpatient dermatology clinic in a tertiary care hospital for clinical assessment due to primary AE in the period from 1996 to 2014. Results A total of 315 patients were identified with primary AE. The most frequent subtype was idiopathic AE (42.5%) and the second most common was angiotensin-converting enzymeinhibitor (ACEi)-induced AE (31.1%). Three patients were diagnosed with hereditary AE and one patient was diagnosed with acquired C1-inhibitor deficiency. At least 107 (34.0%) patients had established histaminergic AE. More than 1/3 of the patients were treated in an emergency room or hospitalized due to AE. A 98.1% of patients had experienced AE in the head and neck area. Seven patients were in the need of acute airway intervention. Six of these had ACEi-induced AE. Female sex and smoking were found to be risk factors for developing AE. Conclusion The most frequent diagnoses were histaminergic-, non-histaminergic idiopathic AE and ACEi-induced AE, whereas complement C1-inhibitor deficiency was rare. Histaminergic AE made up a substantial group of patients with primary AE. Even though there are different pathophysiological causes of AE, many cases have overlapping clinical manifestations, which make diagnosis and treatment difficult.
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Affiliation(s)
- Amalie Hartvig Pall
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anne Fog Lomholt
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anette Bygum
- OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Dermatology and Allergy Centre, Odense University Hospital, Odense 5000, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
| | - Eva Rye Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Genome-wide association study of angioedema induced by angiotensin-converting enzyme inhibitor and angiotensin receptor blocker treatment. THE PHARMACOGENOMICS JOURNAL 2020; 20:770-783. [PMID: 32080354 PMCID: PMC7674154 DOI: 10.1038/s41397-020-0165-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 12/22/2022]
Abstract
Angioedema in the mouth or upper airways is a feared adverse reaction to angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) treatment, which is used for hypertension, heart failure and diabetes complications. This candidate gene and genome-wide association study aimed to identify genetic variants predisposing to angioedema induced by these drugs. The discovery cohort consisted of 173 cases and 4890 controls recruited in Sweden. In the candidate gene analysis, ETV6, BDKRB2, MME, and PRKCQ were nominally associated with angioedema (p < 0.05), but did not pass Bonferroni correction for multiple testing (p < 2.89 × 10−5). In the genome-wide analysis, intronic variants in the calcium-activated potassium channel subunit alpha-1 (KCNMA1) gene on chromosome 10 were significantly associated with angioedema (p < 5 × 10−8). Whilst the top KCNMA1 hit was not significant in the replication cohort (413 cases and 599 ACEi-exposed controls from the US and Northern Europe), a meta-analysis of the replication and discovery cohorts (in total 586 cases and 1944 ACEi-exposed controls) revealed that each variant allele increased the odds of experiencing angioedema 1.62 times (95% confidence interval 1.05–2.50, p = 0.030). Associated KCNMA1 variants are not known to be functional, but are in linkage disequilibrium with variants in transcription factor binding sites active in relevant tissues. In summary, our data suggest that common variation in KCNMA1 is associated with risk of angioedema induced by ACEi or ARB treatment. Future whole exome or genome sequencing studies will show whether rare variants in KCNMA1 or other genes contribute to the risk of ACEi- and ARB-induced angioedema.
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Morgenthau A, Kim E. Angioedema secondary to amlodipine and lisinopril: a documented progression. BMJ Case Rep 2019; 12:12/9/e232019. [PMID: 31501178 DOI: 10.1136/bcr-2019-232019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ari Morgenthau
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Euiseok Kim
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of General Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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