enalapril and Mouth-Diseases

Angiotensin converting enzyme inhibitors (ACEi) are widely used for the treatment of multiple conditions such as hypertension, heart failure and chronic kidney disease. Angioedema is a rare but potentially fatal complication of ACEi use and unilateral tongue edema is a very rare presentation. We report a case of a 55-year-old man, with a history of hypertension, on enalapril for three years, who presented to the hospital with unilateral tongue swelling, without airway compromise. Other causes were excluded and the diagnosis of angioedema due to enalapril was established. The patient was discharged with discontinuation of ACEi with total resolution of symptoms and without relapse after several months. Although very rare, unilateral tongue swelling should be considered in the presentation of angioedema associated with ACEi. Tight surveillance is important to prevent fatal complications such as airway obstruction. ACEi discontinuation is crucial to avoid clinical relapse.. Os inibidores da enzima de conversão da angiotensina (iECAs) são amplamente usados no tratamento de várias patologias como a hipertensão arterial, insuficiência cardíaca e doença renal crónica. O angioedema é uma complicação rara mas potencialmente fatal desta medicação e o edema unilateral da língua é uma apresentação rara desta condição. Reportamos o caso de um homem de 55 anos com hipertensão, medicado há três anos com enalapril, que à admissão hospitalar apresentava edema unilateral da língua sem compromisso da via aérea. Outras etiologias foram excluídas, tendo-se assumido o diagnóstico de angioedema associado ao enalapril. Após suspensão do iECA os sintomas diminuíram progressivamente, sem recorrência do quadro após vários meses. Ainda que raro, o edema unilateral da língua deve ser considerado na apresentação do angioedema associado a iECA. É importante uma vigilância apertada para prevenir complicações fatais, tais como a obstrução da via aérea. A descontinuação do iECA é fundamental para evitar recidiva.

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Edema; Enalapril; Humans; Hypertension; Male; Middle Aged; Mouth Diseases; Recurrence; Tongue; Tongue Diseases

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Drug Eruptions; Drug Therapy, Combination; Enalapril; Facial Dermatoses; Humans; Male; Middle Aged; Mouth Diseases

Pemphigus vegetans, a rare form of pemphigus vulgaris, consists of vegetating plaques localized to flexural areas. Two types, the Neumann and the Hallopeau type, are recognized with their own characteristics.. Three patients with pemphigus vegetans were examined, two with Hallopeau type and one with Neumann type. The microscopic and immunofluorescence findings were recorded.. Two remarkable features were present. In one case pemphigus vegetans was possibly induced by the use of enalapril. Only in three previous cases has enalapril been described in relation to pemphigus. A second case was associated with a malignant lung tumor, a phenomenon which could not be traced in the literature.. Two types of pemphigus vegetans must be distinguished. Induction of pemphigus (also vegetans) is an accepted side effect of captopril. The effect of enalapril on pemphigus is still in debate. To the best of our knowledge, this is the first time that a patient with pemphigus vegetans and a simultaneously occurring internal malignancy is described.

Topics: Aged; Atenolol; Carcinoma, Squamous Cell; Enalapril; Eosinophils; Female; Humans; Lung Neoplasms; Lymphocytes; Male; Middle Aged; Mouth Diseases; Pemphigus

Topics: Adult; Aged; Angioedema; Cheilitis; Dairy Products; Drug Hypersensitivity; Enalapril; Female; Food Hypersensitivity; Gingival Hyperplasia; Gingivitis; Granuloma; Humans; Hypersensitivity; Melkersson-Rosenthal Syndrome; Mouth Diseases; Pesticides; Spices

Few drug reactions are more life threatening than the sudden development of edema involving the mucosal and submucosal layers of the upper aerodigestive tract. Drug-induced angioedema is a recognized entity of angiotensin-converting enzyme (ACE) inhibitors, and despite reports in medical journals and drug insert warnings, captopril and enalapril continue to be widely prescribed. As these drugs are efficacious and usually well-tolerated in the treatment of mild forms of hypertension, their popularity is rising. From June 1, 1984 to August 1, 1991, 36 patients with angioedema secondary to ACE inhibitors presented at the Medical College of Virginia Hospitals. Thirty were successfully managed with medical therapy. Two were intubated, 1 had placement of a nasal trumpet, and 3 required tracheostomies. Of extreme importance is the recognition that angioedema resulting from ACE inhibitors is probably not immunoglobulin E (IgE) mediated and that antihistaminics and steroids may not alleviate the airway obstruction. The otolaryngologist must be prepared for the need of possible early surgical intervention.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Captopril; Dexamethasone; Dipeptides; Diphenhydramine; Enalapril; Epinephrine; Female; Humans; Injections, Intravenous; Laryngeal Edema; Lisinopril; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Prognosis

Angiotensin-converting enzyme (ACE) inhibitors are now in widespread use for the treatment of essential and renovascular hypertension. Consequently, angioedema, an uncommon complication of ACE inhibitor therapy is being encountered with increasing frequency. Since ACE inhibitor angioedema predominantly involves the face, lips, oral cavity, and occasionally the larynx the otolaryngologist is often consulted to evaluate affected patients. Treatment ranges from simple cessation of the drug to emergent airway intervention. The pertinent pharmacologic properties of ACE inhibitors and the pathophysiology of angioedema are discussed. The authors' experience with the evaluation and treatment of ACE inhibitor induced angioedema is presented.

Topics: Adrenal Cortex Hormones; Aged; Angioedema; Captopril; Diphenhydramine; Enalapril; Female; Humans; Laryngeal Diseases; Male; Middle Aged; Mouth Diseases

The use of angiotensin-converting enzyme inhibitors (captopril and enalapril) to control hypertension has increased in recent years. Despite extensive reports of hematologic, gastrointestinal, and cutaneous side effects, no specific incidence of oral mucosal lichenoid reactions caused by these drugs have been reported. It is the purpose of this article to present two case reports, bringing the attention of clinicians to oral mucosal lichenoid drug reactions in which these drugs may be implicated.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Captopril; Enalapril; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases

Angioedema that occurs in the head and neck may be a serious and possibly life-threatening condition. We present two cases of oropharyngeal angioedema associated with the use of angiotensin-converting enzyme inhibitors in patients with no underlying renal failure. Angiotensin-converting enzyme-inhibiting agents are now commonly used to control hypertension. Treatment of acquired angioedema is directed first at protecting the airway by careful observation, intubation, or if necessary, tracheostomy. The causative agent is withdrawn, and the patient is treated with antihistamines and steroids until the acute episode resolves. Although not used in our patients, the treatment of angioedema with subcutaneous epinephrine has been described. As more patients are treated with angiotensin-converting enzyme inhibitors, it becomes essential for the otolaryngologist to become aware of this potentially life-threatening complication.

Topics: Airway Obstruction; Angioedema; Captopril; Enalapril; Female; Humans; Middle Aged; Mouth Diseases; Pharyngeal Diseases

Topics: Angiotensin-Converting Enzyme Inhibitors; Captopril; Dipeptides; Enalapril; Female; Glossalgia; Humans; Hypertension; Male; Middle Aged; Mouth Diseases; Proline