Barely There But Existent: Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema

We describe a 62-year-old female patient who presented to the Accident & Emergency (A&E) department with upper airway edema. Her past medical history included hypertension, obstructive sleep apnea, and ischemic heart disease. She had been previously hospitalized for a lower respiratory infection. On this occasion, she presented with upper airway swelling secondary to angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema, requiring endotracheal intubation. Initial management in the A&E department, under differential consideration for anaphylaxis and Ludwig's angina, included oxygen via a non-rebreather mask (NRM), intramuscular adrenaline, intravenous dexamethasone, nebulization with Pulmicort, and antibiotic coverage with ceftriaxone and metronidazole. Despite these measures, progressive airway edema necessitated intubation. The patient was subsequently transferred to a Level 4 hospital under the care of the maxillofacial team, managed conservatively, and maintained on ventilation until the edema resolved. Surgical intervention was deemed unnecessary. ACEI-induced angioedema is a rare but potentially life-threatening adverse effect of ACEIs, which are widely prescribed for hypertension, heart failure, and chronic kidney disease. A thorough medication history is essential for the timely recognition and management of this condition.