Key result
Perindopril-induced angioedema developed in a 61-year-old male 7 years after initiating therapy and resolved following discontinuation of the medication.
Why the study?
ACE-I-induced angioedema is a rare and potentially life-threatening side effect that typically develops within the first year of therapy, making late-onset presentations challenging to diagnose.
Case Report (n=1)
ACE inhibitor-induced angioedema can present as a late-onset adverse effect several years after initiating therapy, requiring ongoing clinical vigilance.
Prompts vigilance for life-threatening ACE-I angioedema; leaves open mechanisms in novel presentations and requires prospective study.
Background and Clinical Significance: Angiotensin-converting enzyme inhibitors (ACE-Is) are commonly used for treatment of hypertension and are well known among primary care specialists. ACE-I-induced angioedema is a rare, yet possible side effect. It should not be taken lightly, as it can be life-threatening. It is characterized by erythematous or skin-coloured, self-limiting, localized, non-pitting swelling of the submucosal and/or subcutaneous layers of tissue. Usually, it develops in the first year of using the medication, although it can also start several years after using it. Herein, we describe a late-onset ACE-I-induced angioedema, which developed 7 years after using the ACE-I. This case report depicts the challenges of diagnosing ACE-I-induced angioedema, especially if it is late-onset. It highlights the importance of actively asking patients questions about possible side effects of medication even several years after using it and the patients themselves not having any complaints. Case Presentation: We present a 61-year-old Caucasian male with recurring swelling of the lips, tongue and an uncomfortable feeling in the throat, which started 7 years after using an ACE-I: perindopril. There was no airway obstruction or urticaria in any of the episodes. Hereditary angioedema was ruled out by blood analysis. Based on the clinical presentation, images and blood analysis, it was diagnosed as late-onset ACE-I-induced angioedema. After discontinuing the ACE-I, there were two more episodes of angioedema reported, which were a lot milder in symptoms and lasted a shorter time period. Since then, there have been no other episodes of angioedema. Conclusions: It is important to keep in mind angioedema as a possible side effect for patients on ACE-Is. Patients should be regularly and actively questioned about side effects, even if the medication has been started several years ago and no complaints are brought up by the patient.
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Tirāne et al. (2026) conducted a case report in ACE-I-induced angioedema (n=1). Perindopril was evaluated. Perindopril-induced angioedema developed in a 61-year-old male 7 years after initiating therapy and resolved following discontinuation of the medication.
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