A 79-Year-Old Man With Angioedema

A 79-year-old man with a history of hypertension, hyperlipidemia, and type II diabetes presented to a community hospital with significant swelling to his tongue and lips consistent with angioedema (AE). Given the amount of peroral swelling with which he presented, his history of present illness was fairly limited because of his acute physical constraints, but he was able to communicate that he woke up that morning with the previously described physical findings, placed his wife in his car, and drove himself to the hospital. He noted that he had no changes in his medications for quite a significant time and has had no new environmental exposures but has been taking lisinopril for greater than a decade for his hypertension. Additionally, he had been taking medications for diabetes, hyperlipidemia, and opiates for chronic pain. Since waking up this morning, he noted that he was not able to manage his secretions and had been drooling significantly. He could breathe effectively through his nose. He denied any constitutional signs or symptoms and denied any pruritus or urticaria. His wife, who accompanied him that day, had a history of severe dementia and was unable to provide any additional information. Peter V.R. Tilney, DO, FACEP, EMT-P, is a board-certified emergency physician at Central Maine Medical Center in Lewiston. He is also a medical director for LifeFlight of Maine and can be reached at [email protected] Sam Schaab is a flight nurse at LifeFlight of Maine. He also serves as the clinical operations manager for the organization. Dianne Irving is a flight paramedic at LifeFlight of Maine.