Unilateral Orolingual Angioedema in a Patient with Sarcoidosis After Intravenous Thrombolysis Due to Acute Stroke Without Improvement After Treatment with Icatibant

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2020 Dec 29

PMID 33370942

Citations 2

Authors

Anna Daniela Wollmach

Daniel Zehnder

Markus Schwendinger

Alexander Andrea Tarnutzer

Affiliations

Soon will be listed here.

Abstract

A potential complication after intravenous administration of recombinant tissue plasminogen activators (rtPAs) for thrombolysis in acute ischaemic stroke is orolingual angioedema, with an incidence of 0.4%-7.9%. In the herewith reported case, we discuss potential links between a history of sarcoidosis and the occurrence of orolingual angioedema after rtPA administration. Sarcoidosis is often accompanied by an elevated ACE level. In contrast, low ACE levels appear to play a role in the pathomechanism currently assumed to trigger angioedema, that is, the activation of the bradykinin and complement pathways. Medication with ACE inhibitors is considered a risk factor for angioedema. Based on these considerations, the patient was also treated with icatibant, a bradykinin B2-receptor antagonist, which has been found useful in recent publications on treating orolingual angioedema after intravenous lysis in ischaemic stroke.

Citing Articles

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