ACE阻害薬が原因と考えられた喉頭血管性浮腫例

抄録

Angioedema, a deep-seated edema that appears in localized areas of the skin and mucous membranes, could be classified as urticaria in a broad sense, but in contrast to normal urticaria, is not accompanied by erythema and pruritus. It occurs most commonly on the face, especially involving the lips and eyelids, and occasionally causes airway edema, which could cause suffocation.

We report a case of emergent surgical airway management for angioedema causing airway obstruction; the patient presented with angioedema more than 3 years after he had been initiated on treatment with an angiotensin-converting enzyme (ACE) inhibitor, one of the major classes of antihypertensive drugs. The patient presented to us with an acute attack of angioedema. The swelling of the lips and tongue was so intense that it was difficult to intubate, and we decided to perform surgical airway management. Thereafter, the swelling of the tongue and larynx decreased steadily by the day and the patient was discharged. However, even after discharge from the hospital, the patient presented with similar recurring episodes. Later, a neighborhood doctor implicated the ACE inhibitor intake as the potential cause.

Common features of ACE inhibitor-induced angioedema (ACEI-AE) are that they more often induce edema in the head and neck region as compared to other drugs, and that the interval from the start of intake of the drug to the appearance of symptoms varies from case to case.