SHM Converge Scientific Abstract ePoster Gallery-Blood Pressure Medication Gives a Punch to the Gut: Unmasking Lisinopril Induced Intestinal Angioedema

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This case report describes a rare but important adverse effect of lisinopril, an ACE inhibitor commonly used to treat hypertension: intestinal angioedema. While ACE inhibitor angioedema usually affects the lips, tongue, or face, it can occasionally involve the gastrointestinal tract, making diagnosis more difficult because symptoms are nonspecific.<br /><br />A 60-year-old woman with morbid obesity, type 2 diabetes, obstructive sleep apnea, and uncontrolled hypertension was started on lisinopril 20 mg daily after presenting to the emergency department with headache and elevated blood pressure. Two days later, she returned with severe diffuse abdominal pain, watery diarrhea, nausea, and vomiting. She was hemodynamically stable, and exam showed only mild abdominal tenderness. CT imaging demonstrated small bowel wall thickening, mesenteric stranding, and reactive free fluid. Laboratory findings showed leukocytosis, elevated hemoglobin, and elevated hematocrit, while electrolytes, stool studies, and EKG were unremarkable.<br /><br />Based on the recent initiation of lisinopril, her gastrointestinal symptoms, and the characteristic CT findings, the authors concluded that she had lisinopril-induced intestinal angioedema. The report emphasizes that this diagnosis is often missed because symptoms can mimic gastroenteritis, ischemia, or other abdominal disorders, and because there is usually no associated facial swelling. The condition may also resolve after stopping the ACE inhibitor, which can further delay recognition.<br /><br />The authors stress that clinicians should maintain a high index of suspicion for ACE inhibitor-induced intestinal angioedema in patients who develop unexplained abdominal pain after starting lisinopril or another ACE inhibitor. Careful medication history and awareness of this rare complication are essential for timely diagnosis and management.

Asset Subtitle

Danny Aiti

Meta Tag

Author List Ameed Bawwab, Danny Aiti, Kevin Frey, Lana Khatib

Category Clinical Vignettes

Concept Lisinopril

Concept Intestinal Angioedema

Concept ACE Inhibitor

Concept Abdominal Pain

Concept Medication History

Distinguished Non-Finalist

Presenter Organization Canton Medical Education Foundation/Northeast Ohio Medical University

Presenting Author Danny Aiti

Track Adult

Keywords

lisinopril

ACE inhibitor

intestinal angioedema

abdominal pain

small bowel wall thickening

computed tomography

gastrointestinal symptoms

hypertension

adverse drug reaction

medication-induced angioedema

Lisinopril

Intestinal Angioedema

ACE Inhibitor

Abdominal Pain

Medication History