Chronic ACE-Inhibitor Induced Angioedema Requiring Emergent Nasotracheal Intubation: A Case Report

Abstract

ACE-inhibitor induced angioedema is a rare, potentially life-threatening phenomenon with unpredictable symptoms. With advanced angioedema, orotracheal intubation may not be possible necessitating nasotracheal intubation or cricothyroidotomy. This case describes a 76-year-old male with a history of hypertension controlled with lisinopril-hydrochlorothiazide who developed sudden-onset angioedema. Additionally, this case was complicated by the patient’s anticoagulation after recent abdominal aortic aneurysm repair. The patient’s acute respiratory distress was managed with nasotracheal intubation because of severe edema of the oral cavity including at the base of the tongue without improvement with epinephrine, a corticosteroid, or an antihistamine. He was extubated the following day, but mild edema of the oral cavity and left side of face persisted at discharge 4 days after presentation. When presenting to the emergency room with angioedema mediated via ACE-inhibitor use, time is of the essence to avoid cardiopulmonary arrest secondary to hypoxemia. Rapid identification and management of this condition is key to improve outcomes. After acute management, patients should be advised to avoid all ACE-inhibitors in the future.