Angioedema is sudden local swelling of the lips, eyelids, buccal region and tongue. It is usually induced by drugs. Angioedema is a well-recognized side effect of angiotensin-converting enzyme inhibitors (ACEs), but angioedema associated angiotensin II receptors blockers (ARBs) is very rare. We report a case of angioedema of the tongue and floor of the mouth that was probably induced by an ARB.
A 76-year-old man came to our emergency unit because of acute swelling of the tongue and difficulty breathing.
He had a medical history of hypertension and cerebral infarction, but no allergic disease. He had severe diffuse edematous swelling of the submandibular and cervical regions, an elevated tongue making it difficult to close his mouth, and sialorrhea.
Although urgent computed tomography showed marked swelling of the tongue, there was no evidence of edema in the respiratory tract. Angioedema of the tongue was diagnosed, and hydrocortisone sodium succinate was given intravenously. Within 12 hours the swelling of the tongue and floor of the mouth resolved completely.Candesartan was strongly suspected to have caused the angioedema, and we discontinued it. There has been no evidence of recurrence of the angioedema during the 18 months since candesartan was discontinued.