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Tongue angioedema as an adverse effect to mycophenolate
Med Clin (Barc). 2015;145(10):464
www.elsevier.es/medicinaclinica
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Tongue angioedema as an adverse effect to mycophenolate夽 Angioedema de lengua como efecto adverso a micofenolato ˜ a,∗ , Pedro Castro Rebollo a , Ricard Cervera Segura b , J. María Nicolás Arfelis a Olga Rodríguez Núnez a b
Área de Vigilancia Intensiva (AVI), Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, Spain Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, Spain
Fig. 1.
A 20-year-old woman, diagnosed with systemic lupus erythematosus (SLE) 7 months before, who started corticoid treatment due to pulmonary involvement, developing steroid-induced psychosis. To reduce the doses of corticosteroids, mycophenolate therapy (360 mg/day orally) was started, developing a tongue angioedema (Fig. 1A) at the time of administration which required nasotracheal intubation. With no certainty about the angioedema’s etiology (its association with SLE has been described and there is no clear evidence for mycophenolate), the patient received a second dose at 24 h with protected airway, which worsened the condition. C1 esterase inhibitor levels were normal. With the discontinuation of treatment, the patient experienced a slow improvement of the angioedema, requiring a temporary tracheostomy. After 20 days, the tongue regained its original appearance (Fig. 1B).
夽 Please cite this article as: Rodríguez Núnez ˜ O, Castro Rebollo P, Cervera Segura R, Nicolás Arfelis JM. Angioedema de lengua como efecto adverso a micofenolato. Med Clin (Barc). 2015;145:464. ∗ Corresponding author. ˜ E-mail address: [email protected] (O. Rodríguez Núnez). ˜ S.L.U. All rights reserved. 2387-0206/© 2015 Elsevier Espana,
www.elsevier.es/medicinaclinica
Image of the week
Tongue angioedema as an adverse effect to mycophenolate夽 Angioedema de lengua como efecto adverso a micofenolato ˜ a,∗ , Pedro Castro Rebollo a , Ricard Cervera Segura b , J. María Nicolás Arfelis a Olga Rodríguez Núnez a b
Área de Vigilancia Intensiva (AVI), Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, Spain Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, Spain
Fig. 1.
A 20-year-old woman, diagnosed with systemic lupus erythematosus (SLE) 7 months before, who started corticoid treatment due to pulmonary involvement, developing steroid-induced psychosis. To reduce the doses of corticosteroids, mycophenolate therapy (360 mg/day orally) was started, developing a tongue angioedema (Fig. 1A) at the time of administration which required nasotracheal intubation. With no certainty about the angioedema’s etiology (its association with SLE has been described and there is no clear evidence for mycophenolate), the patient received a second dose at 24 h with protected airway, which worsened the condition. C1 esterase inhibitor levels were normal. With the discontinuation of treatment, the patient experienced a slow improvement of the angioedema, requiring a temporary tracheostomy. After 20 days, the tongue regained its original appearance (Fig. 1B).
夽 Please cite this article as: Rodríguez Núnez ˜ O, Castro Rebollo P, Cervera Segura R, Nicolás Arfelis JM. Angioedema de lengua como efecto adverso a micofenolato. Med Clin (Barc). 2015;145:464. ∗ Corresponding author. ˜ E-mail address: [email protected] (O. Rodríguez Núnez). ˜ S.L.U. All rights reserved. 2387-0206/© 2015 Elsevier Espana,