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CC BY 4.0 · TH Open 2020; 04(01): e33-e35
DOI: 10.1055/s-0040-1701238
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Lisinopril-Induced Angioedema in a Patient with Plasma Prekallikrein Deficiency

Swapan K. Dasgupta
1   Department of Pathology, Baylor College of Medicine, Houston, Texas, United States
,
Stefanie Rivera
1   Department of Pathology, Baylor College of Medicine, Houston, Texas, United States
,
Perumal Thiagarajan
1   Department of Pathology, Baylor College of Medicine, Houston, Texas, United States
2   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
3   Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
› Author Affiliations Funding This study was supported in part by a grant from the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development (to P.T.), a grant from National Institutes of Health (HL139501 to P.T.). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Further Information

Publication History

26 August 2019

20 December 2019

Publication Date:
23 January 2020 (online)

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Abstract

Angiotensin-converting enzyme (ACE) inhibitors are extensively prescribed to treat patients with hypertension, congestive heart failure, and diabetic nephropathy. A small fraction of these patients (approximately 0.7%) develop angioedema, manifested by swelling of the lips and oropharynx. Angioedema of oropharynx is a medical emergency that can lead to asphyxiation and death. The angioedema is due to bradykinin generated from high molecular weight kininogen by kallikrein, which is derived from plasma prekallikrein by action of the factor XIIa, factor Xia, or prolylcarboxypeptidase. Bradykinin induces vasodilation and increased vascular permeability. ACE is the major degrading enzyme of bradykinin in the intravascular department. ACE inhibitors inhibit the proteolytic inactivation of bradykinin. We report a patient with oropharyngeal angioedema associated with an ACE inhibitor with complete absence of plasma prekallikrein due to homozygous mutation (Ser97PhefsTer173).

Keywords

bradykinin - prekallikrein - kininogen

Authors’ Contribution

P.T. analyzed and interpreted the data and wrote the manuscript. S.K.D. and S.R. performed the sequencing.


 

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