Acute Angioedema in a 56-Year-Old Male with Bipolar Disorder
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-9-2025
Abstract
Angioedema is the swelling of subcutaneous and submucosal tissues caused by increased vascular permeability. The causes of angioedema can be categorized as hereditary, allergic, acquired, or idiopathic. One unique cause is cocaine-induced angioedema. First described in 1999 by Castro-Villamor and colleagues, the pathophysiology of cocaine-induced angioedema is unclear, but many mechanisms have been proposed. The purpose of this case report is to present a rare case of cocaine-induced angioedema.
Angioedema is the swelling of subcutaneous and submucosal tissues caused by increased vascular permeability. The causes of angioedema can be categorized as hereditary, allergic, acquired, or idiopathic. One unique cause is cocaine-induced angioedema. First described in 1999 by Castro-Villamor and colleagues, the pathophysiology of cocaine-induced angioedema is unclear, but many mechanisms have been proposed. The purpose of this case report is to present a rare case of cocaine-induced angioedema.
In the intensive care unit, the patient received dexamethasone, diphenhydramine, and famotidine. The patient was extubated on Day 3 of admission with significant improvement in upper airway edema. C1q, C1 esterase antigen, and tryptase were all within normal limits. It was confirmed that the patient had never been on ACE inhibitors or had a history of angioedema. The urine drug screen was positive for cocaine. Given the patient's history, the angioedema was most likely induced by cocaine.
Physicians should be aware of cocaine use as a possible cause of angioedema and the need to do testing in unclear cases. Treatment consists of H1 and H2 blocking drugs, steroid therapy, and, if indicated, epinephrine. Adequate counseling to patients of this dangerous complication of cocaine use may prevent recurrent episodes of this life-threatening emergency.
Recommended Citation
Piromari R, Rauch L, Ambrose L. Acute angioedema in a 56-year-old male with bipolar disorder. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1705