benazepril and Angioedema

SARS-CoV-2, the virus responsible for COVID-19, binds to the ACE2 receptors. ACE2 is thought to counterbalance ACE in the renin-angiotensin system. While presently it is advised that patients should continue to use ACE inhibitors or angiotensin receptor blockers, questions still remain as to whether adverse effects are potentiated by the virus. Here, we report a case of a 57-year-old man, unknowingly with COVID-19, who presented to the emergency department with tongue swelling, shortness of breath and difficulty in speaking following 4 months taking benazepril, an ACE inhibitor. Finally, we also describe possible pathways that exist for SARS-CoV-2 to interact with the mechanism behind angioedema.

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Anti-Allergic Agents; Benzazepines; Betacoronavirus; Coronavirus Infections; COVID-19; Diagnosis, Differential; Diphenhydramine; Famotidine; Histamine H2 Antagonists; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; SARS-CoV-2; Tranexamic Acid

A 52-year-old African American male with a long history of poorly controlled hypertension presented to the emergency department (ED) with two days of genital edema and pain. During ED work-up, the patient developed sudden onset of non-pitting, non-pruritic, and non-urticarial upper lip edema. Review of his antihypertensive medication list revealed that he normally took benazepril, highly suggestive of a diagnosis of angiotensin-converting-enzyme inhibitor-related angioedema (ACEI-RA). We present the first reported case of penile ACEI-RA that progressed to involve the oropharynx. The ED management of the condition and some of the newer treatment options available for ACEI-RA is also briefly discussed.

Topics: Alcoholism; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Humans; Lip; Male; Middle Aged; Oropharynx; Penile Diseases; Penis

Cough and angioedema are well-known adverse reactions of ACE inhibitors. However, other adverse effects of upper airways such as postnasal drainage, rhinitis and nasal blockage, are less frequently recognised. These might share the same pathophysiological mechanism: bradykinin accumulation. We present two patients with ACE inhibitor-induced upper respiratory symptoms that improved after the discontinuation of ACE-inhibitors and substitution with angiotensin II receptor blockers. The incidence of these adverse events is not accurately known, since these are not required to be reported, but it is estimated to be low. This presents challenges to the physician and demonstrates the importance of keeping it as a differential diagnosis. Most physicians are aware of ACE inhibitor-induced cough but not of ACE inhibitor-induced nasal blockage, rhinitis or postnasal drainage. Identifying these can avoid unnecessary diagnostic tests and inappropriate treatment.

Topics: Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Cough; Humans; Male; Nasal Obstruction; Nose; Rhinitis

Topics: Adrenal Cortex Hormones; Aged, 80 and over; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Female; Histamine H1 Antagonists; Humans; Hypertension; Tongue Diseases

Angiotensin converting enzyme inhibitors are one of the most commonly prescribed medications and angioedema of upper aerogastric tracts is a well recognized complication. Isolated visceral angioedema with the use of angiotensin converting enzyme inhibitors is rare and is relatively under diagnosed. The visceral angioedema should be considered in patients taking angiotensin converting enzyme inhibitors who develop gastrointestinal complaints. We report a case of subacute intestinal obstruction from the use of benazepril, which was promptly resolved after withdrawing benazepril.

Topics: Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Diagnosis, Differential; Female; Humans; Hypertension; Intestinal Diseases; Viscera

Topics: Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Female; Humans; Tongue Diseases

Topics: Aged; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Benzazepines; Female; Follow-Up Studies; Humans; Time Factors

This is a case report on a 45-year old African-American female with newly diagnosed hypertension, who was started on a combination pill of amlodipine/benazapril 10/5 mg. The very next day, she presented at the emergency room (ER) with abdominal pain, nausea and vomiting. Physical exam, complete metabolic panel, and hemogram were in the normal range. She was discharged from the ER after a few hours of treatment with fluid and analgesics. However, she returned to the ER the next day with the same complaints. This time the physical exam was significant for a distended abdomen with dullness to percussion. CT scan of the abdomen revealed markedly thickened antrum of the stomach, duodenum and jejunum, along with fluid in the abdominal and pelvic cavity. Angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema was suspected, and anti-hypertensive medications were discontinued. Her symptoms improved within the next 24 hours, and repeat CT after 72 hours revealed marked improvement in stomach and small bowel thickening and resolution of ascites. The recognition of angiotensin-converting enzyme (ACE) and angiotensin receptor blocker (ARB) intestinal angioedema constitutes a challenge to primary care physicians, internists, emergency room personal and surgeons.

Topics: Amlodipine; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Calcium Channel Blockers; Female; Humans; Hypertension; Intestine, Small; Middle Aged; Stomach; Tomography, X-Ray Computed

Topics: Acute Disease; Amlodipine; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Benzazepines; Dexamethasone; Drug Interactions; Histamine Antagonists; Humans; Infarction, Middle Cerebral Artery; Male; Middle Aged; Mouth; Stroke; Tissue Plasminogen Activator; Tongue; Treatment Outcome