A Rare Case of Valsartan-Induced Angioedema

Abstract

Angioedema of the face and neck is a rare but potentially life-threatening condition induced by angiotensin-converting enzyme (ACE) inhibitors. While ACE inhibitors are commonly implicated, recent reports suggest angiotensin II receptor blockers (ARBs) may also trigger angioedema. This case report highlights the development of angioedema in a patient on valsartan, an ARB, emphasizing the importance of recognizing ARBs as a potential cause of this condition, even in patients with no prior history of swelling. A 77-year-old male with coronary artery disease, hypertension, and type 2 diabetes presented to the emergency department with sudden-onset tongue swelling and difficulty breathing. The patient had been on valsartan for several years without any prior episodes of swelling. Upon examination, he had significant tongue swelling, and multiple hemorrhagic blisters were observed. Laboratory results indicated mild inflammation and C1 esterase inhibitor levels were normal, supporting a diagnosis of non-hereditary angioedema. Treatment included steroids, epinephrine, and diphenhydramine. Valsartan was discontinued and replaced with nifedipine. The patient improved, and the swelling resolved without airway obstruction. This case underscores the need for heightened awareness of angioedema induced by ARBs like valsartan. Early recognition and discontinuation of the offending medication are key to successful management. In drug-induced angioedema without airway compromise, supportive care is typically sufficient, and the condition is self-limiting. Proper identification of the cause and timely intervention are crucial to avoid life-threatening complications.

Keywords: anaphylaxis; angioedema; angiotensin ii receptor blocker; bradykinin; c1 esterase inhibitor; hypertension.