ACE Inhibitors: An unusual Cause of Pediatric Angioedema

Background: Angiotensin converting enzyme inhibitors (ACEI) are widely used to treat hypertension in adults. The use of these drugs in pediatric age is increasing due to the higher prevalence of obesity and its co-morbidities’.

Objective: To alert pediatric community about angioedema as ACEI side effect.

Methods: Report of clinical case from a suburban hospital in Portugal.

Clinical Report: Fifteen year-old african descendent female with morbid obesity, hypertension, diabetes mellitus type 2 followed in cardiovascular risk outpatient clinic. Treated with lisinopril since December 2017.

During hospital admission in January 2019, she developed labial and tongue edema followed by asymmetric periorbital involvement, without itching nor urticaria, unresponsive to high dose hydroxyzine. Lisinopril was discontinued and no other therapeutic measures were taken. Clinical manifestations gradually disappeared during the following five days. The patient reported a similar episode five months before that resolved spontaneously, without therapy changes.

Conclusion: In adults, angioedema is an unusual but well-recognized side effect of ACEI therapy, up to five times greater in African descents. However, in the “pediatric world”, physicians are less familiar and therefore less alert to possible ACEI side effects. Although benign and self-limited, ACEI induced angioedema can be potentially fatal, therefore physicians should consider this possibility when evaluating patients with acute or recurrent angioedema.