Trinitas Regional Medical Center, Elizabeth, NJ, USA.
Kansas City University, Kansas City, MO, USA.
J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211033049. doi: 10.1177/23247096211033049.
The patient is a 69-year-old male with a past medical history of intellectual disability, hypertension, type 2 diabetes mellitus, and angiotensin-converting enzyme (ACE) inhibitor-associated angioedema who presented to the emergency department with difficulty breathing. On physical examination, the patient had significant facial edema. Nasal fiber-optic visualization revealed extensive airway edema involving the supraglottic region and the arytenoids. The patient was successfully intubated through the collective teamwork of ENT, anesthesia, and critical care teams. He was managed in the intensive care unit until recovery. Workup for markers for allergic causes of angioedema were within normal limits. Further investigation revealed that symptoms developed following the initiation of a dipeptidyl peptidase 4 (DPP-IV) inhibitor. The angiotensin-converting enzyme and DPP-IV play a significant role in the metabolism of bradykinin and substance P to their inactive metabolites. The complex interplay between the enzymes in the high-molecular-weight kininogen (HWMK) system may increase the risk of angioedema in patients with a known history of ACE inhibitor-associated angioedema when placed on a DPP-IV inhibitor. This case report highlights the pathophysiology involved.
患者为 69 岁男性，既往有智力障碍、高血压、2 型糖尿病和血管紧张素转换酶（ACE）抑制剂相关性血管水肿病史，因呼吸困难就诊于急诊科。体格检查发现患者有明显的面部水肿。鼻纤维光学检查显示，声门上区域和杓状软骨有广泛的气道水肿。在耳鼻喉科、麻醉科和重症监护团队的共同协作下，患者成功进行了气管插管。他在重症监护病房接受治疗，直至康复。血管水肿过敏原因标志物检查在正常范围内。进一步调查发现，症状是在开始使用二肽基肽酶 4（DPP-4）抑制剂后出现的。ACE 和 DPP-4 在缓激肽和 P 物质代谢为无活性代谢物方面发挥着重要作用。在高分子量激肽原（HMWK）系统中，酶之间的复杂相互作用可能会增加已知 ACE 抑制剂相关性血管水肿病史的患者在使用 DPP-4 抑制剂时发生血管水肿的风险。本病例报告强调了相关的病理生理学。
