Abstract
Intestinal angioedema caused by angiotensin-converting enzyme inhibitors such as lisinopril is rare but well documented in the literature. Patients with this condition typically present with common symptoms such as diffuse abdominal pain, cramping, nausea, and emesis. Imaging is needed to reveal segmental edema of the small intestine, often associated with free fluid in the abdomen. The authors report 2 cases of intestinal angioedema caused by angiotensin-converting enzyme inhibitors. Awareness of this allergic reaction and careful history taking—noting temporal relationship to occurrence of symptoms—are essential to diagnose this condition; laboratory and radiologic findings are needed to confirm the diagnosis. An accurate diagnosis helps the patient recover quickly and avoid complications from unnecessary tests and invasive procedures.
Intestinal angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is rare. As of 2010, according to Campbell et al,
1 21 cases have been reported in the medical literature. Differential diagnoses include inflammatory bowel disease, enteritis, vasculitis, and ischemic bowel. Most often, patients are middle-aged women with complaints of acute, severe abdominal pain, nausea, or emesis. These symptoms can occur within days to weeks after the initiation of an ACE inhibitor. Other conditions frequently encountered are leukocytosis, ascites, and angioedema of the small intestine. Peripheral edema usually does not accompany visceral findings. Most patients are seen by multiple physicians and may undergo exploratory surgical procedures, including endoscopy, biopsy, and intestinal resection.
2 Treatment for patients with this condition is discontinuation of the ACE inhibitor. Patients have undergone repeated surgical procedures, however, because of recurrent symptoms when the medication was reintroduced postoperatively.
3 Awareness of this potential drug reaction is important because lisinopril is the most-prescribed antihypertensive and the fourth most-prescribed drug in the United States, having been prescribed more than 42.2 million times in 2011.
4
We present 2 cases of ACE inhibitor–induced intestinal angioedema.