SHM Converge Scientific Abstract ePoster Gallery-Unilateral Angioedema Induced by Lisinopril, a Case Report

Pdf Summary

This case report describes an uncommon presentation of ACE inhibitor–induced angioedema caused by long-term lisinopril use. An 86-year-old man with hypertension developed sudden left-sided facial swelling and voice changes. Examination showed asymmetric edema of the face, tongue, and neck, and imaging confirmed soft tissue swelling consistent with angioedema. Because the presentation could mimic infection, the patient was evaluated for cellulitis, parotitis, abscess, odontogenic infection, and sinusitis, but the workup was negative.<br /><br />He was treated emergently with antihistamines, corticosteroids, intramuscular epinephrine, tranexamic acid, and fresh frozen plasma. His swelling improved significantly, and he was admitted to the ICU for airway monitoring. Lisinopril was identified as the likely trigger and was permanently discontinued. The angioedema resolved completely without recurrence during hospitalization.<br /><br />The discussion emphasizes that ACE inhibitor–associated angioedema is rare but potentially life-threatening, occurring in about 0.1% to 1% of treated patients. It is usually bradykinin-mediated, which explains the absence of urticaria and allergic triggers. While typical cases involve bilateral swelling of the lips or tongue, unilateral tongue or facial swelling is unusual and may be mistaken for infection or other obstructive conditions. Possible reasons for the asymmetry include differences in lingual nerve sensitivity and structural barriers within the tongue.<br /><br />The key takeaway is that clinicians should consider ACE inhibitor–induced angioedema in any patient with isolated or asymmetric tongue, facial, or neck swelling, even after long-term ACE inhibitor use. Early recognition, prompt treatment, stopping the ACE inhibitor, and readiness for airway intervention are essential for patient safety.

Asset Subtitle

Hamza Saifuddin

Meta Tag

Author List April Emmons, Emre Keskin, Hamza Saifuddin, Logan Wallace

Category Clinical Vignettes

Concept ACE Inhibitor

Concept Bradykinin-mediated angioedema

Concept Airway Compromise

Concept Unilateral Angioedema

Concept Tongue Swelling

Distinguished Non-Finalist

Presenter Organization Corewell Health

Presenting Author Hamza Saifuddin

Track Adult

Keywords

ACE inhibitor

lisinopril

angioedema

facial swelling

tongue swelling

bradykinin-mediated

airway monitoring

ICU admission

tranexamic acid

unilateral edema

ACE Inhibitor

Bradykinin-mediated angioedema

Airway Compromise

Unilateral Angioedema

Tongue Swelling