title: Drug-induced isolated visceral angioneurotic edema.
abstract: A 44-year-old woman on maintenance hemodialysis was admitted to our hospital because of severe abdominal pain. The patient had been medicated with lisinopril and valsartan for hypertension for one month prior to admission. An abdominal computerized scan (CT) showed a dilated and thickened loop of the small bowel with massive ascites and a small nodule in the jejunum. The patient's abdominal pain was thought to be due to isolated visceral angioneurotic edema induced by lisinopril and/or valsartan, and medication of these two drugs was therefore stopped. Her symptoms resolved and an abdominal CT demonstrated almost complete resolution of ascites and of small bowel edema except for a small nodule in the jejunum. A laparoscopic operation was performed to excise the small nodule of the jejunum, and a histological diagnosis of accessory pancreas of the jejunum was made. This is the first report of isolated visceral angioneurotic edema induced by lisinopril and/or valsartan in a patient on maintenance hemodialysis and, moreover, with the association of accessory pancreas of the jejunum.
authors.affiliation: Department of Internal Medicine, Ishinomaki Red Cross Hospital, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Arakawa
authors.forename: Yaeko
authors.initials: Y
authors.lastname: Murata
authors.forename: Yuya
authors.initials: Y
authors.lastname: Rikimaru
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000799:Angioedema / Q000139:chemically induced* / Q000175:diagnosis; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D017706:Lisinopril / Q000009:adverse effects*; D006435:Renal Dialysis; D013777:Tetrazoles / Q000009:adverse effects*; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives*; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D017706:Lisinopril; D014633:Valine