Angiotensin-converting Enzyme Inhibitor-mediated Angioedema Suspected of being Induced by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 44; no. 2; pp. 141 - 146
• Main Authors: Matsumoto, Kenji, Hayashi, Nobuyoshi
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.03.2022; 特定非営利活動法人 日本呼吸器内視鏡学会
• Subjects: ACE inhibitor; Angioedema; DPP-4 inhibitor; DPP-4阻害薬; EBUS-TBNA; Prostate cancer; アンギオテンシン変換酵素阻害薬; 前立腺癌; 血管性浮腫; 超音波気管支鏡ガイド下針生検
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.44.2_141

Background. Angioedema can progress from edema of the tongue and lips to pharyngeal and laryngeal edema, resulting in life-threatening airway stenosis; therefore, appropriate treatment at the onset is important. Case. A 75-year-old male smoker receiving anticancer drug therapy for prostate cancer underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to examine the right lower paraventricular lymphadenopathy. No complications occurred within 24 h after the operation; however, angioedema developed after 48 h. The angiotensin-converting enzyme (ACE) inhibitor enalapril and dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin, which can exacerbate ACE inhibitor-mediated angioedema, were discontinued. Hydrocortisone succinate was infused; however, the patient's angioedema worsened. An emergency tracheostomy was performed. Thereafter, the air conduction stenosis due to edema was improved. Conclusion. We encountered a patient with prostate cancer who developed ACE inhibitor-mediated angioedema that may have been triggered by EBUS-TBNA. Angioedema due to ACE inhibitors rarely occurs; however, invasive procedures, such as EBUS-TBNA, may trigger the development of angioedema to ACE inhibitors if there are risk factors, such as smoking and DPP-4 inhibitor use.