Blood pressure drug lisinopril causes gut swelling in man, 54, in rare case
Unexplained abdominal pain diagnosed as intestinal angioedema: Report
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A 54-year-old man with sudden, unexplained abdominal pain was diagnosed with intestinal angioedema — marked by swelling of the gastrointestinal tract — linked to the use of the common blood pressure drug lisinopril, according to a case report.
His symptoms resolved quickly after stopping treatment with the medication, often prescribed for people with high blood pressure and heart failure. Lisinopril eases tightened blood vessels, helping the heart pump blood more efficiently, but its use can lead to swelling in some individuals, the researchers noted.
The team says this man’s case highlights the need to examine a patient’s history to look for potential angioedema triggers when unexplained belly pain or swelling occurs.
“In patients presenting with unexplained acute abdominal pain, careful review of medication history is essential to ensure timely diagnosis and to avoid unnecessary invasive interventions,” the researchers wrote.
Their report, “An Uncommon Case of Bowel Angioedema Due to Lisinopril,” was published in the journal Cureus.
Angioedema is a condition marked by swelling of the deep layers of the skin or mucosal tissues. When triggered by medications rather than allergies, it most often occurs as a side effect of angiotensin-converting enzyme (ACE) inhibitors. These medicines are commonly prescribed to manage high blood pressure and other heart-related conditions. One such drug is lisinopril.
Unlike typical allergic reactions, which are driven by histamine and often cause hives, ACE inhibitor-induced angioedema is caused by bradykinin. Bradykinin is a natural chemical in the body that makes blood vessels leaky and promotes swelling. ACE inhibitors block the breakdown of bradykinin, allowing it to build up. This excess bradykinin increases blood vessel permeability, causing fluid to leak into surrounding tissues and leading to swelling.
Abdominal pain can be sign of intestinal angioedema
ACE inhibitor-associated angioedema typically affects the face, lips, tongue, or throat, where swelling can interfere with breathing. In rare cases, it can also involve the gastrointestinal tract, leading to abdominal pain. However, because gut involvement is uncommon, ACE inhibitor-related angioedema may be misdiagnosed in these patients, the researchers noted.
Here, a research team from the Northeast Georgia Medical Center Gainsville reported the case of a man in his 50s who sought emergency room treatment for sudden, severe abdominal pain. The man’s symptoms began shortly after starting lisinopril, an ACE inhibitor he was prescribed for newly diagnosed high blood pressure.
His pain worsened after his second dose and became severe enough to prompt an urgent medical evaluation, the team noted.
Initial exams and blood tests were largely normal, and common causes of acute abdominal pain — such as heart attack, bowel obstruction, pancreas inflammation, or kidney stones — were ruled out. Clinicians also found no evidence of diverticulitis, a condition in which small pouches in the colon (large intestine) become inflamed or infected.
A CT scan of the abdomen, however, showed swelling and inflammation in portions of the small intestine known as the jejunum and the final part of the colon. Additionally, the patients had fluid in the abdomen, but no signs of infection, blockage, or reduced blood flow.
Imaging plays a crucial role in identifying atypical manifestations [in people with unexplained abdominal pain], particularly gastrointestinal involvement.
Because his symptoms closely followed the start of lisinopril and there was no history suggesting hereditary angioedema — when the condition is genetic — the patient was diagnosed with ACE inhibitor-induced intestinal angioedema.
The researchers noted that the tmaging findings supported the diagnosis and helped distinguish it from more common gastrointestinal conditions.
Stopping lisinopril quickly eased man’s symptoms
Lisinopril was immediately discontinued, and the patient received steroids, an antiallergic medication, and a drug to reduce the acidic content of the stomach. He was also treated for a slow heart rate. His symptoms diminished quickly, and he was discharged the next day without complications, the team reported.
Overall, according to the researchers, this case report highlights how “imaging plays a crucial role in identifying atypical manifestations, particularly gastrointestinal involvement that may mimic an acute abdomen.” The team added that “timely diagnosis, immediate drug cessation, and increased clinical awareness remain the most effective strategies for management” in these cases.
