ACE inhibitors can cause life-threatening angio-oedema even several months after treatment initiation, requiring prompt cessation and emergency treatment.
Clinicians must remain vigilant for delayed angio-oedema on ACE inhibitors; this case report leaves open incidence and risk-factor quantification.
We report the case of a patient who, 9 months after initiation of enalapril and hydrochlorothiazide combination treatment for hypertension, developed angio-oedema with near fatal outcome. Our patient was successfully intubated using a flexible bronchofiberoscope. This case demonstrates that patients given an angiotensin-converting enzyme (ACE) inhibitor may develop serious facial and laryngeal swelling even several months after the initiation of treatment. The occurrence of even mild swelling should lead to prompt cessation of the drug. Patients with incipient ACE inhibitor-related angio-oedema should, without any delay, be referred to hospital for emergency treatment.
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Forslund et al. (1995) studied this question.
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