A Rare Case of Unilateral Tongue Edema with Angiotensin Converting Enzyme Inhibitors.

Angiotensin converting enzyme inhibitors (ACEi) are widely used for the treatment of multiple conditions such as hypertension, heart failure and chronic kidney disease. Angioedema is a rare but potentially fatal complication of ACEi use and unilateral tongue edema is a very rare presentation. We report a case of a 55-year-old man, with a history of hypertension, on enalapril for three years, who presented to the hospital with unilateral tongue swelling, without airway compromise. Other causes were excluded and the diagnosis of angioedema due to enalapril was established. The patient was discharged with discontinuation of ACEi with total resolution of symptoms and without relapse after several months. Although very rare, unilateral tongue swelling should be considered in the presentation of angioedema associated with ACEi. Tight surveillance is important to prevent fatal complications such as airway obstruction. ACEi discontinuation is crucial to avoid clinical relapse.

Os inibidores da enzima de conversão da angiotensina (iECAs) são amplamente usados no tratamento de várias patologias como a hipertensão arterial, insuficiência cardíaca e doença renal crónica. O angioedema é uma complicação rara mas potencialmente fatal desta medicação e o edema unilateral da língua é uma apresentação rara desta condição. Reportamos o caso de um homem de 55 anos com hipertensão, medicado há três anos com enalapril, que à admissão hospitalar apresentava edema unilateral da língua sem compromisso da via aérea. Outras etiologias foram excluídas, tendo-se assumido o diagnóstico de angioedema associado ao enalapril. Após suspensão do iECA os sintomas diminuíram progressivamente, sem recorrência do quadro após vários meses. Ainda que raro, o edema unilateral da língua deve ser considerado na apresentação do angioedema associado a iECA. É importante uma vigilância apertada para prevenir complicações fatais, tais como a obstrução da via aérea. A descontinuação do iECA é fundamental para evitar recidiva.

Angioedema of the tongue due to haloperidol.

BACKGROUND: Angioedema is an allergic reaction that has rarely been associated with haloperidol. There are 3 case reports in the literature, including one involving a child. Angioedema is mediated by increased capillary permeability and plasma extravasation, either related to histamine/IgE or bradykinin. When triggered by a medication, it typically presents within a few hours of medication administration. Histamine-mediated angioedema is generally treated with corticosteroids, antihistamines, and/or epinephrine. CASE PRESENTATION: We review a case of angioedema of the tongue in an adolescent, thought to be triggered by haloperidol. Initial treatment was targeted toward a presumed dystonic reaction. Telephone consent was obtained from the patient's mother to publish this report. CONCLUSIONS: Clinicians should be aware of potential dangerous adverse effects of commonly used medications. Patients with angioedema may need to be monitored for up to 36 h.

Solifenacin-induced acute urticaria and angioedema: a rare adverse effect.

Antimuscarinics are first-line medication for management of overactive bladder with solifenacin being commonly prescribed. Angioedema is the swelling of mucosa and submucosal tissue. There are no published case reports of drug-induced angioedema involving solifenacin. We report a case of a 41-year-old man with spinal cord injury who presented with oedema of face, lips, tongue and associated pruritic urticaria after taking 5 mg of solifenacin. All other possible causes including food allergy, insect bite, hereditary angioedema, use of NSAIDs, ACE inhibitors and antibiotics were ruled out. The temporal association between solifenacin and angioedema and complete resolution of symptoms after discontinuing the drug suggest that solifenacin was the most probable cause of angioedema in our patient.

Extensive tissue necrosis of the tongue in a methamphetamine user: A case report.

AIMS: Methamphetamine (meth) is a powerful, highly addictive stimulant that affects the central nervous system, and its side effects may result in severe self-mutilation. This report describes a case of a meth user with severe oral injury that demonstrates the necessity for prompt treatment when severe tongue biting occurs. METHODS AND RESULTS: A 43-year-old meth-using man with severe tongue biting was left untreated for more than 24 hours, resulting in extensive ischemic changes in the tongue and eventual extensive tissue necrosis. After debridement and deep suture repair in several layers, the wound healed. However, tongue dysfunction and a speech disorder remained because of tongue shortening. CONCLUSION: Meth may induce or aggravate severe oral self-mutilation. Tongue biting with severe tissue damage may occur as oral self-mutilation in meth users; however, among self-mutilation behaviors, tongue biting is especially difficult to prevent. A withdrawal from meth and a behavioral approach may be necessary for fundamental prevention, but it is often difficult in high dependence users. When severe tongue biting occurs, prompt suture reconstruction must be performed before ischemic change occurs to prevent tissue necrosis.

Medication-related fibrovascular hyperplasia lesion in tongue: Case report.

OBJECTIVE: The objective of this study is to report the case of a patient who underwent hematopoietic stem cell transplantation for Hodgkin's lymphoma treatment and developed multiple tongue lesions during recovery. METHODS AND RESULTS: This is the case report of a patient who developed ulcerated lesions with areas of depapillation on the border and dorsum of the tongue. The ulcer evolved to a reddish fibrous hyperplastic nodule, similar to adjacent mucosa. The patient was using a series of medications, such as antifungals, antibiotics, antivirals, corticosteroids, and analgesics in addition to immunosuppression with cyclosporine. Considering the medical history of the patient, a biopsy was performed. Histopathological analyses describe hyperplasia, granulation tissue, vascular proliferation, and intense inflammatory infiltrate, and the diagnosis was of medication-related fibrovascular hyperplasia (MRFH). CONCLUSION: Patients in use of cyclosporine are at risk to develop oral lesions, such as MRFH. The correct diagnosis is important, so the adequate treatment and follow-up are instituted even considering the immunosuppression protocol.

[Treatment of alteplase-induced orolingual angioedema by means of icatibant]. / Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.

TITLE: Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.

[A case of angioedema with dysarthria mimicking transient ischemic attack].

An 85-year-old woman was transported to our emergency room by ambulance with a complaint of slurred speech. Neurological examination revealed dysarthria only. We considered that lingual edema identified on physical examination might have influenced dysarthria. However, we were unable to perform sufficient evaluation, since she could not open her mouth widely or push the tongue out beyond the lips. We considered the incidence of acute cerebrovascular disease because of the acute onset, and performed emergency brain MRI. Imaging revealed that although no abnormality was present in the brain parenchyma, edema of the tongue and soft palate was evident on T2-weighted sagittal imaging. We confirmed the dysarthria was caused by tongue edema due to angioedema. In addition, we diagnosed angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema, because ACEI had been started 2 months earlier as pharmacotherapy for hypertension. Tongue swelling due to angioedema should be considered when examining patients with dysarthria.

Ecstasy Abuse and Its Effects on the Oral Mucosa.

Ecstasy is an illicit drug that has been increasingly abused by young people. This synthetic drug has both stimulant and hallucinogenic effects and is usually consumed in a tablet. The side effects of ecstasy use include nausea, muscle cramping, fever, and symptoms mostly linked to muscular tension including jaw pain, facial pain, and headaches. There are few studies assessing the ecstasy effects on the oral mucosa, both clinically and histopathologically. The authors report 2 young women (22- and 27-year-old) who presented multifocal oral erosions and ulcerations. The lesions were painful and covered by a yellow-white pseudomembrane with a bright erythematous halo. By microscopy, it was observed superficial ulceration surrounded by acanthotic squamous epithelium with marked spongiosis, interstitial edema within the corion and perivascular lyphoid infiltrate, suggesting drug-induced oral mucositis. In conclusion, ecstasy use may be associated with the development of oral ulcers, which should be considered in the differential diagnosis when assessing multifocal oral ulcerations, especially in young people.

Hemilingual Angioedema after Thrombolysis in a Patient on an Angiotensin II Receptor Blocker.

Orolingual angioedema (OLAE) is a rare adverse effect of alteplase. Previous studies have associated the occurrence of OLAE with thrombolysed patients maintained on angiotensin converting enzyme inhibitors. We report a case of a 60-year-old male presenting with hyperacute ischemic stroke developing hemilingual edema after thrombolysis. He was previously maintained on an angiotensin II receptor blocker (ARB), losartan. The swelling resolved over 2 days with immediate administration of intravenous steroids and antihistamine drugs. Our case is the third documented case of OLAE occurring in a thrombolysed patient concurrently taking an ARB. The presence of hemilingual edema in a post-thrombolysis patient maintained on losartan suggests a possible association between OLAE and ARBs.