A 64-Year-Old Man With Throat Swelling

Patricia Ayuk Noumedem, PharmD; Marissa Tabile; Ermias Shikur; Bini Mathews; Anthony L. Huynh; Tracy Kwaku


August 08, 2018

This patient case was quite rare in that he was hospitalized for about 10 days and heavily sedated due to the severity of his tracheal swelling and the difficulty he experienced with breathing. The patient was not arousable, and his oxygen saturation was about 82% due to the extensive swelling of his tongue, which was blocking his airway passage. Reversibility of angioedema after discontinuation of the offending agent, lisinopril, proved to be an arduous task. In most cases, corticosteroid therapy as well as diphenhydramine therapy is sufficient to resolve the swelling and irritation. Novel therapy (icatibant) was considered because the patient's condition remained unchanged for 10 days.[3] Numerous studies have demonstrated the benefit of new therapies in some patients who did not respond to antihistamines or steroids. However, the cost of these therapies is quite high.[3,5] A study by Sinert and colleagues[9] found that icatibant was ineffective in the treatment of ACE-induced angioedema.

This patient received two units of fresh frozen plasma and was then immediately transferred to a nearby hospital, where more invasive care was provided.[10] He was administered a nasotracheal intubation to secure his airway and carefully monitored until symptom resolution. His symptoms improved, and he was discharged home 2 days later. Prior to discharge, the patient received counseling to avoid ACE inhibitors and other medications associated with a risk for angioedema. This patient should also avoid use of angiotensin-receptor blockers, which have demonstrated similar reactions.[11] He was also provided with an epinephrine kit for future emergencies.


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