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Thread: Clinical Case: Angioedema of the Tongue

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    Default Clinical Case: Angioedema of the Tongue

    Angioedema of the Tongue


    Summary points:

    An 86-year-old on antihypertensive treatment for 12 years presents with 6-hour history of acute, painless, nonpruritic tongue swelling with no symptoms of upper airway obstruction or dyspnea.

    This case report describes the physical examination, the diagnosis, and treatment outcome, and includes an photograph.

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    We diagnosed ACE-inhibitor-induced angioedema and discontinued benazepril therapy. She was given intravenous steroids and antihistamines. There was no initial improvement, but within 2 days her tongue returned to normal size. The patient was given a different antihypertensive medication, and she remained symptom-free several months later.

    Angioedema is acute, self-limited localized swelling of subcutaneous or mucosal tissue. It often affects the lips, eyelids, face, tongue, larynx or bowel, and often causes large, well-demarcated lesions that typically resolve in 2–3 days but may last 5–7 days. Angioedema affects 0.1%–0.5% of patients taking ACE inhibitors and may develop hours or years after therapy is initiated. Its onset may be idiopathic or the result of diverse causes such as nonsteroidal anti-inflammatory drugs, antibiotics, insect bites, food or environmental allergens and complement-inhibitor deficiencies. Cross reactivity with other types of ACE inhibitors is common, and a change of drug classes is necessary to prevent a recurrence. Treatments for angioedema are dependent on the underlying cause and may include antihistamines, corticosteroids, epinephrine and tranexamic acid.

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    Dilation of Renal Artery Stenosis after Administration of Losartan

    A 22-year-old with hypertension presents with renal artery stenosis of fibromuscular dysplasia that was difficult to dilate even by cutting-balloon angioplasty. This case report details the approach to management, and includes a series of images. The present case suggests the possibility of remodelling the renal artery during the normotensive state by administering losartan after the angioplasty.

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