SHM Converge Scientific Abstract ePoster Gallery-Empagliflozin-Induced Angioedema: A Rare Case of Hypersensitivity to an Sglt2 Inhibitor

Pdf Summary

This case report describes a rare episode of angioedema likely triggered by empagliflozin, an SGLT2 inhibitor, in a 68-year-old woman with heart failure, asthma, hypertension, and a prior history of ARB/NSAID-induced angioedema. About 12 hours after her first dose of empagliflozin, she developed lip and tongue swelling, pruritic rash, dysphagia, muffled voice, and visible edema of the soft palate and uvula. Direct laryngoscopy confirmed oropharyngeal edema.<br /><br />Her labs showed mild leukocytosis and normal complement C4 and C1 esterase inhibitor levels, which argued against hereditary angioedema. Because the mechanism was unclear and her history suggested possible severe hypersensitivity, clinicians treated her for both histamine- and bradykinin-mediated angioedema. She received IM epinephrine, IV diphenhydramine, famotidine, methylprednisolone, and tranexamic acid, and was monitored in the ICU for airway protection. She improved and was discharged on day 4 with cetirizine, a prednisone taper, and an epinephrine auto-injector.<br /><br />The authors note that angioedema can be life-threatening and is typically mediated by either histamine or bradykinin. While SGLT2 inhibitors are not commonly linked to angioedema, rare hypersensitivity reactions have been reported. In this patient, empagliflozin was considered the most likely trigger because there were no other new exposures and the timing strongly matched drug initiation. Her urticaria, pruritus, and response to antihistamines supported a histamine-mediated reaction.<br /><br />The report concludes that empagliflozin may cause histamine-mediated angioedema and that SGLT2 inhibitors should be considered in the differential diagnosis of new-onset angioedema, especially in patients with prior hypersensitivity reactions.

Asset Subtitle

Emily Leventhal

Meta Tag

Author List Alfred Burger, Caroline Johnson, Emily Leventhal, Simran Ohri, Vincent Torelli, William He

Category Clinical Vignettes

Concept Empagliflozin

Concept Angioedema

Concept Airway involvement

Concept Allergic Angioedema

Concept Bradykinin-mediated angioedema

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai

Presenting Author Emily Leventhal

Track Adult

Keywords

angioedema

empagliflozin

SGLT2 inhibitor

hypersensitivity reaction

histamine-mediated

bradykinin-mediated

oropharyngeal edema

epinephrine

airway protection

drug-induced angioedema

Empagliflozin

Angioedema

Airway involvement

Allergic Angioedema

Bradykinin-mediated angioedema