Abstract Introduction Angiotensin-converting enzyme inhibitor(ACEI)-induced angioedema is a rare but potentially life-threatening adverse effect, most often presenting with swelling of the lips, tongue, or oropharynx. It is caused by bradykinin accumulation, causing increased vascular permeability and producing localized edema. Isolated supraglottic edema is an uncommon presentation that can cause rapid airway compromise and may be mistaken for infectious etiologies. Case Presentation A 91-year-old male with a history of coronary artery disease status post coronary artery bypass grafting (CABG), diabetes mellitus, and hypertension presented with worsening shortness of breath over six weeks. He reported a sensation of something “stuck” in his throat and worsening dyspnea on exertion. He was recently hospitalized for similar complaints, where an infectious workup was negative, and he was treated with nebulizations. On presentation, imaging confirmed severe concentric supraglottic soft tissue swelling with marked narrowing and compromise of the supraglottic airway. No evidence of epiglottitis, abscess, or tongue swelling. His home medications included Enalapril for hypertension. Given the absence of an infectious or allergic cause, ACEI-induced angioedema was suspected. He was monitored closely in the ICU, where he received fresh frozen plasma and tranexamic acid. Over the next forty-eight hours, he improved, never requiring intubation. Discussion This case highlights a rare presentation of isolated supraglottic edema secondary to ACEI use. Clinicians should maintain a high index of suspicion for ACEI-induced angioedema in patients presenting with unexplained upper airway swelling or dyspnea, even in the absence of facial or tongue edema. Prompt recognition and discontinuation of the offending agent are vital to prevent airway compromise and recurrence. While epinephrine, steroids, and antihistamines are often administered, their benefit is limited due to non-histaminergic mechanisms. This abstract is funded by: None
Lone et al. (Fri,) studied this question.