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Unilateral orolingual angioedema in a patient with sarcoidosis after intravenous thrombolysis due to acute stroke without improvement after treatment with icatibant
  1. Anna Daniela Wollmach1,
  2. Daniel Zehnder2,
  3. Markus Schwendinger1 and
  4. Alexander Andrea Tarnutzer3,4
  1. 1Emergency Medicine, Cantonal Hospital of Baden, Baden, Aargau, Switzerland
  2. 2Internal Medicine, Cantonal Hospital of Baden, Baden, Aargau, Switzerland
  3. 3Neurology, Cantonal Hospital of Baden, Baden, Aargau, Switzerland
  4. 4Faculty of Medicine, University of Zurich, Zürich, Switzerland
  1. Correspondence to Dr Alexander Andrea Tarnutzer; atarnutzer{at}gmail.com

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.

  • primary care
  • cerebral palsy
  • stroke

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Footnotes

  • Contributors ADW was involved in the initial assessment of the patient on the emergency department (ED). She drafted the manuscript. MS was involved in the initial assessment of the patient on the ED and in the intensive care unit (ICU). AAT was involved in the initial assessment of the patient on the ED and on the ICU. He was involved in drafting the manuscript. DZ was in charge of the patient while she was on the ward. All authors have critically read the manuscript and have approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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