Researchers presented the study of a patient who experienced a rare case of losartan-induced angioedema in Cureus.
This type of acute angioedema has the same symptoms but is different from hereditary angioedema, which is caused by a deficiency of C1 inhibitor (C1-INH).
A 48-year-old man presented with a 2-day history of dizziness and leg swelling after missing a dialysis session. His comorbidities included end-stage renal failure for which he was on dialysis, acute pancreatitis, diabetes mellitus, and hypertension. In addition, he had a 20 pack-year history of smoking and drank a pint of hard liquor daily (duration unknown).
Continue Reading
Upon physical examination, his physicians found 1+ pitting edema and a right chest Permacath in place. A chest X-ray revealed mild cardiomegaly and bilateral perihilar edema. His laboratory investigations revealed a poor renal profile and an abnormal coagulation profile.
Read more about hereditary angioedema etiology
Upon admission, the patient was on 50 mg of hydralazine every 8 hours, 200 mg of labetalol every 8 hours, and 0.2 mg of clonidine (for his hypertension) as needed. The patient underwent dialysis on day 2 of admission, resulting in the removal of 2.5 L through his right Permacath. On day 3, he was started on 50 mg of losartan daily, given that his mean arterial pressure was still persistently high at 135 mm Hg.
However, just 1 hour after being administered losartan, the patient experienced voice changes, sore throat, and neck swelling. The medication was discontinued. Three hours later, his blood pressure fell, first to 78/53 mm Hg, then to 52/45 mm Hg. His physicians immediately inserted a central line, commenced vasopressors, and shifted the patient to the intensive care unit. Epinephrine, methylprednisolone, diphenhydramine, and racepinephrine were also administered, to no avail.
A decision was made for the patient to undergo tracheostomy intubation. In the 3 days following the procedure, the patient continued to improve on ventilatory and pressor support. He was extubated in another 3 days. Because the patient demonstrated some signs of laryngeal swelling, he was administered a short course of steroids. The patient was eventually able to start eating a complete renal diet a few weeks after the procedure. Unfortunately, he had a cardiac arrest just a few months after this incident of angioedema and passed away.
“To our knowledge, there have only been twenty case reports published to date about losartan-induced angioedema,” the authors wrote. “Angiotensin receptor blocker-induced angioedema, while not fatal in this case, is a serious adverse effect that can quickly lead to death.”
Reference
Mann H, Pandey S, Pokhriyal S, Kusayev J, Dufresne A. Losartan-induced angioedema: a case report. Published online April 19, 2023. doi:10.7759/cureus.37818
