Beaini Hadi, Bjorkman Carol, Johnson Kelly, Araj Faris G
Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, United States.
Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Professional Office Bldg. 2 Suite 600, 5939 Harry Hines Blvd. Dallas, TX, 75390-9252, United States.
Open Med (Wars). 2024 Jan 9;19(1):20230884. doi: 10.1515/med-2023-0884. eCollection 2024.
In the realm of organ transplantation, particularly heart transplantation, angioedema presents a significant challenge. This clinical condition ranges from minor facial edema to life-threatening swelling of vital structures. Its multifactorial etiology involves various factors and mechanisms, including C1 esterase inhibitor deficiency, food allergen hypersensitivity, and adverse drug reactions, notably involving angiotensin-converting enzyme (ACE) inhibitors and mechanistic target of rapamycin inhibitors (mTOR-Is). We present a rare case of sirolimus potentiated angioedema in a patient with long-standing ACE inhibitor therapy.
A 52-year-old male with a history of heart transplant developed severe upper and lower lip edema. The patient had been on Lisinopril without any adverse events. However, sirolimus was recently added to his drug regimen. Sirolimus potentiated angioedema was suspected.
Intravenous methylprednisolone, famotidine, and diphenhydramine were initiated, and both lisinopril and sirolimus were discontinued. The patient showed improvement and was discharged with oral antihistamines.
Transplant physicians should be aware of the life-threatening interaction between ACE inhibitors and mTOR-Is like sirolimus. Consideration should be given to switching from an ACE inhibitor to an angiotensin-receptor blocker when initiating patients on mTOR-Is.
在器官移植领域，尤其是心脏移植中，血管性水肿是一个重大挑战。这种临床病症范围从轻微的面部水肿到危及生命的重要结构肿胀。其多因素病因涉及多种因素和机制，包括C1酯酶抑制剂缺乏、食物过敏原超敏反应以及药物不良反应，尤其是涉及血管紧张素转换酶（ACE）抑制剂和雷帕霉素靶蛋白抑制剂（mTOR-Is）。我们报告一例长期接受ACE抑制剂治疗的患者发生西罗莫司增强型血管性水肿的罕见病例。
一名有心脏移植史的52岁男性出现严重的上下唇水肿。该患者一直在服用赖诺普利，未出现任何不良事件。然而，最近其药物治疗方案中添加了西罗莫司。怀疑是西罗莫司增强型血管性水肿。
开始静脉注射甲泼尼龙、法莫替丁和苯海拉明，并停用赖诺普利和西罗莫司。患者病情好转，出院时带口服抗组胺药。
移植医生应意识到ACE抑制剂与西罗莫司等mTOR-Is之间存在危及生命的相互作用。在开始让患者使用mTOR-Is时，应考虑从ACE抑制剂换用血管紧张素受体阻滞剂。
