title: A Novel Approach to the Treatment of Orolingual Angioedema After Tissue Plasminogen Activator Administration.
abstract: Orolingual angioedema is a rare adverse effect of tissue plasminogen activator (tPA), with an incidence of 1% to 5%. There are currently no published reports describing resolution of tPA-induced orolingual angioedema with complement inhibitor therapy. A 72-year-old man receiving home angiotensin-converting enzyme inhibitor therapy presented to the emergency department with newly developed orolingual angioedema after treatment with tPA for acute ischemic stroke. Therapy was initiated with intravenous methylprednisolone 125 mg, famotidine 20 mg, and diphenhydramine 50 mg, without significant improvement. Because of increased concern for airway protection, plasma-derived C1 esterase inhibitor was administered. Concerns about progressive and airway-threatening orolingual angioedema subsided 2 hours after administration, and invasive airway maneuvers were avoided. Orolingual angioedema is an infrequent, severe adverse effect of tPA for treatment of acute ischemic stroke. Complement inhibitors may be an additional therapeutic option for patients presenting with orolingual angioedema with potential airway compromise that is refractory to standard anaphylactic therapies.
authors.affiliation: University of Cincinnati Medical Center, Cincinnati, OH. Electronic address: lpahs@hotmail.com.
authors.forename: Lesley
authors.initials: L
authors.lastname: Pahs
authors.affiliation: University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Chris
authors.initials: C
authors.lastname: Droege
authors.affiliation: St. John Medical Center, Tulsa, OK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Kneale
authors.affiliation: University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Arthur
authors.initials: A
authors.lastname: Pancioli
mesh_terms: D000368:Aged; D000799:Angioedema / Q000139:chemically induced* / Q000628:therapy; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004155:Diphenhydramine / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015738:Famotidine / Q000008:administration & dosage / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D009059:Mouth Diseases / Q000139:chemically induced* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014060:Tongue Diseases / Q000139:chemically induced* / Q000628:therapy
chemical_list: D000893:Anti-Inflammatory Agents; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D015738:Famotidine; D004155:Diphenhydramine; D010959:Tissue Plasminogen Activator; D008775:Methylprednisolone