Angioedema occurs in up to 5% of patients on angiotensin-converting enzyme inhibitor (ACEI) therapy receiving IV rtPA.1 A 58-year-old man taking the combination ACEI amlodipine/benazepril received IV rtPA for clinical left middle cerebral artery territory acute infarction, NIHSS 9. Head CT was unremarkable. He developed orolingual angioedema 5 minutes after rtPA infusion was completed (figure). There was no airway compromise or hemodynamic instability to suggest anaphylactic reaction. Symptoms were treated with dexamethasone and a histamine antagonist. The angioedema resolved completely over the next 48 hours, as did his neurologic deficits.
Figure. This patient developed severe orolingual angioedema involving predominantly the lower lip with apparent bilateral onset within 5 minutes of completing rtPA infusion. Erythrocyte sedimentation rate, immunoglobulin E, and complete cell count with differential were unremarkable.
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Disclosure: The authors report no conflicts of interest.
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