Case Studies

 Case 4.3 Drug-induced reaction

A 77-year-old woman was referred from the Accident and Emergency Department, having been admitted overnight because of sudden onset of massive angioedema of her tongue associated with laryngeal stridor. She was treated with intravenous hydrocortisone only. This was her fifth such episode: an anaphylactoid attack 2 months earlier was severe enough for her to be intubated and ventilated on the Intensive Care Unit.

She had no history of previous allergy and no family history of atopy. A drug history revealed that, in addition to oral prednisolone prescribed in the Accident and Emergency Department, she was taking oral frusemide and captopril. Captopril is an angiotensin-converting enzyme (ACE) inhibitor and this group of drugs is known to cause severe episodes of angioedema. Captopril was discontinued and her mild hypertension was managed with alternative medication. The attacks have not recurred.