Metformin
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Angioedema: case report A 40-year-old woman developed angioedema during treatment with metformin for diabetes mellitus. The woman presented to the emergency room with a 4-day history of ipsilateral tingling sensation, emesis, multiple diarrhoeal episodes and facial oedema predominantly in the left mid face. One week before the presentation, she was diagnosed with diabetes mellitus and started receiving treatment with metformin 850mg every 12 hours. Upon physical examination, she was in good general condition. Her heart rate was 80 beats per minute, respiratory rate was 12 rpm and bp was 100/60mm Hg. She was alert, oriented, with bilateral angioedema of left predominance and ipsilateral paraesthesia. Her rest of the examination was within normal range. She was suspected to have an adverse drug reaction. Hence, the woman’s metformin therapy was changed to glibenclamide. She also received dexamethasone and loratadine. Consequently, her condition improved and she was discharged on the following day. She was negative for Epstein-Barr IgG Antibodies, anti-neutrophil cytoplasmic antibodies (ANCA), antinuclear antibodies (ANAs), and anti-Epstein-Barr IgM Antibodies. She had elevated serum immunoglobulin E. One month later, her symptoms had returned and she was re-admitted to the emergency room. Upon interrogation, she revealed that she restarted metformin treatment due to high glucose levels. Her results ruled out hereditary angioedema and temporal arteritis. She also reported headache, which was considered as autonomic trigeminal cephalalgia (Horton’s headache). Therefore, she was referred to neurology, where imaging studies ruled out intracranial structural lesions. Metformin treatment was discontinued and monitoring was decided. On the next day, her symptoms were alleviated without further medical treatment. Based on this situation, it was considered that she had angioedema secondary to metformin administration, therefore the glucose lowering treatment was adjusted, thereby alleviating her symptoms. After 3 months, she was again assessed in outpatient consultation, she was asymptomatic with paraclinical studies showing good metabolic control. Rozo-Ortiz EJ, et al. Angioedema induced by metformin. [Spanish]. Medicina Interna de Mexico 36: 237-241, No. 2, Apr 2020. Available from: URL: http://doi.org/10.24245/ 803501930 mim.v36i2.2934 [Spanish; summarised from a translation]
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Reactions 19 Sep 2020 No. 1822
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