Dr Valérie Gras-Champel Clinical Pharmacology University Hospital of Amiens Amiens, France	Prof Z.A. Massy Nephrology and Clinical Pharmacology Departments, University Hospital of Amiens, Amiens, and INSERM U507, Necker Hospital, Paris, France

A 64-year-old woman was admitted to the hospital for swelling of the lips (Fig.1) combined with shortness of breath. She had no pruritus and no erythema. Her medical history consisted of hypertension, moderate renal failure, hypercholesterolemia and gout. For years her treatment had been captopril (50 mg X 2 / day), simvastatin (10 mg/ day), allopurinol (100 mg/day) and postmenopausal hormone replacement therapy.

Figure 1

 

Questions 1 and 2

After the discontinuation of captopril and estrogen, the patient’s symptoms resolved almost immediately. C1-INH dosage, as well as the dosage of C1, C4, and C2, were normal. She was then started on losartan (100 mg/ day) the following day. Within 24 hours, the patient had developed symptoms of facial swelling (Fig.2), including the upper lip and left side of the chin. There was no erythema, pruritus, tenderness or shortness of breath.

Figure 2

 

Question 3

The symptoms resolved after losartan was withdrawn and replaced with atenolol.

Question 4

 

References :

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Acknowledgements: The author is indebted to Prof. Michel Andrejak for revising the manuscript and giving useful suggestions.