Captopril
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Captopril Angioedema and pancreatitis: case report
A 36-year-old woman developed angioedema and acute pancreatitis during treatment with captopril for high blood pressure [not all duration of treatment to reaction onset stated]. The woman presented with vomiting, headache associated with paresthesia of the upper right limb and aphasia. She had medical history of galactorrhea for 1 year. Subsequent physical examination showed mucocutaneous pallor and oliguria. Her BP was 220/100mm Hg. Urine analysis showed haematuria (3+) and proteinuria (2+). Blood test showed creatinine 1125 µmol/L, anaemia (haemoglobin: 6.1 g/dL), thrombocytopenia at 61000/mm3 and lactate dehydrogenase 3154 IU/L. Based on further examination results, a diagnosis of atypical haemolytic uremic syndrome was established by the complement factor-I deficiency. For renal insufficiency, she was placed on peritoneal dialysis. Initially, she started receiving nicardipin, methyldopa and furosemide for high BP. Subsequently, she started receiving angiotensin-converting enzyme inhibitor i.e. captopril [dosage and route not stated]. However, after 12 hours of the first dose, she developed severe epigastric pain with cramps. She was not able to eat and had vomiting twice. Physical examination was significant for only moderate epigastric tenderness. Further examination showed heart rate 88 beats/min, respiratory rate 18 breaths/min with an SPO2 of 99% on room air, body temperature of 37°C, BP 143/85mm Hg and serum lipase 560 IU/L. Abdominal CT revealed a mildly edematous, inflamed pancreas described as stage B pancreatitis. After 24 hours, she developed a marked oedema of the neck region without dysphonia or dyspnoea. Subsequent cervical ultrasound showed an infiltration of the subcutaneous tissues. The captopril induced angioedema was suspected. The woman’s captopril was therefore stopped. The oedema disappeared gradually. Her serum lipase decreased to 350 IU/L. At the end of 4th day, serum lipase normalised. Gorsane I, et al. Simultaneous acute pancreatitis and angioedema associated with angiotensin-converting enzyme inhibitor. Saudi Journal of Kidney Diseases and Transplantation 30: 1479-1484, No. 6, Nov 2019. Available from: URL: http://doi.org/10.4103/1319-2442.275498
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Reactions 29 Aug 2020 No. 1819
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