Sir, a 72-year-old female presented to her general medical practitioner with an acute onset (over four hours) of facial angioedema (AE) involving the tongue, lips and floor of mouth. She had been on Lisinopril for four months for treatment of hypertension. On examination, her upper lip was significantly swollen to at least double the normal size (Fig. 1).

Figure 1
figure 1

Diffuse painless swelling of the upper lip

Full size image

Her airway was not compromised and she had no other symptoms.

There were no other identifiable causes of the AE and the patient made a rapid recovery overnight with oral steroid and antihistamine treatment. Lisinopril was changed to a calcium channel blocker alternative.

Angioedema (AE) often presents as facial swelling, but can progress to involve the tongue, oropharynx and supraglottic regions. Although classified as a rare side effect, AE is associated with the use of angiotensin converting enzyme inhibitors (ACEI) such as Lisinopril.

The onset of AE with the use of ACEI can range from within the first 3-4 weeks to several years of treatment.1 High risk groups include Afro-Caribbeans, those older than 65 years of age and patients with known drug-related allergies.2

Patients who present to general practice with facial swelling with no obvious oral-dental disease should have their past medical history checked and in particular the use of ACEI should be highlighted as a possible cause.