Atorvastatin as a Rare Primary Cause of Drug-Induced Angioedema: A Case Report

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Abstract

In patients with hyperlipidemia and cardiovascular disease, statin remains the primary medication for risk reduction. Statins are primarily associated with adverse outcomes like myoglobinuria and deranged liver function tests (LFTs). Angioedema is a life-threatening reaction characterized by mucosal and submucosal swelling. It is rarely known for its association with statins. However, we present a rare case of a 59-year-old man presenting with recurrent angioedema of the face and tongue after starting on 40mg of atorvastatin, within one week of the treatment. He had no previous history of hypersensitivity and rash. He denied any food or medication allergy in the past. The Naranjo scale probability and the abrupt nature of these episodes upon starting statin and completely resolving after discontinuing the drug made statin-induced angioedema the primary diagnosis in this case.

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Most cited references 9

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A consensus parameter for the evaluation and management of angioedema in the emergency department.

Joseph Moellman, Jonathan A Bernstein, Christopher Lindsell … (2014)

Despite its relatively common occurrence and life-threatening potential, the management of angioedema in the emergency department (ED) is lacking in terms of a structured approach. It is paramount to distinguish the different etiologies of angioedema from one another and more specifically differentiate histaminergic-mediated angioedema from bradykinin-mediated angioedema, especially in lieu of the more novel treatments that have recently become available for bradykinin-mediated angioedema. With this background in mind, this consensus parameter for the evaluation and management of angioedema attempts to provide a working framework for emergency physicians (EPs) in approaching the patient with angioedema in terms of diagnosis and management in the ED. This consensus parameter was developed from a collaborative effort among a group of EPs and leading allergists with expertise in angioedema. After rigorous debate, review of the literature, and expert opinion, the following consensus guideline document was created. The document has been endorsed by the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM).

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Bradykinin B2 receptor knockout mice are protected from thrombosis by increased nitric oxide and prostacyclin.

Ayad Jaffa, Laine Murphey, Zia Shariat-Madar … (2006)

Bradykinin (BK) liberates nitric oxide, prostacyclin, and tissue plasminogen activator from endothelial cells. We hypothesized that BK B2 receptor knockout (KO) mice (BKB2R(-/-)) have increased thrombosis risk. Paradoxically, the BKB2R(-/-) mice have long bleeding times and delayed carotid artery thrombosis, 78 +/- 6.7 minutes, versus 31 +/- 2.7 minutes in controls. The mechanism(s) for thrombosis protection was sought. In BKB2R(-/-) plasma coagulation, fibrinolysis and anticoagulant proteins are normal except for an increased prekallikrein and decreased factor XI. BKB2R(-/-) mice have elevated BK 1-5 (160 +/- 75 fmol/mL, vs 44 +/- 29 fmol/mL in controls) and angiotensin II (182 +/- 41 pg/mL, vs 49 +/- 7 pg/mL in controls). Ramipril treatment shortens vessel occlusion time. BKB2R(-/-) mice have elevated plasma 6-keto-PGF1alpha (666 +/- 232 ng/mL, vs 23 +/- 5.3 ng/mL in controls) and serum nitrate (61 +/- 5.3 microM, vs 24 +/- 1.8 microM in controls). Treatment with L-NAME (NG-mono-methyl-L-arginine ester) or nimesulide shortens the thrombosis time. BKB2R(-/-) mice have increased angiotensin receptor 2 (AT2R) mRNA and protein expression. Treatment with an AT2R antagonist, PD123 319, normalizes the thrombosis time and nitrate and 6-keto-PGF1alpha. The long bleeding times in BKB2R(-/-) mice also correct with L-NAME and nimesulide therapy. In BKB2R(-/-) mice, angiotensin II binding to an overexpressed AT2R promotes thromboprotection by elevating nitric oxide and prostacyclin. These investigations indicate a pathway for thrombosis risk reduction via the plasma kallikrein/kinin and renin angiotensin systems.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 5 September 2022

Publication date (Electronic, collection): September 2022

Volume: 14

Issue: 9

Electronic Location Identifier: e28788

Affiliations

[1 ] College of Medicine, University of Michigan, Ann Arbor, USA

[2 ] Internal Medicine, University of Sulaymaniyah, Sulaymaniyah, IRQ

[3 ] Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, USA

[4 ] General Practice, Swan Practice, Manchester, GBR

[5 ] Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK

[6 ] Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK

[7 ] Internal Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK

Author notes

Faraz Saleem raofarazsaleem38@ 123456gmail.com

Article

DOI: 10.7759/cureus.28788

PMC ID: 9533254

SO-VID: 38299658-c986-4707-8209-0c83ce78c0c6

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date accepted : 5 September 2022

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