WERE SARS-COV-2 OR ACE-I RESPONSIBLE FOR ANGIOEDEMA OR WAS IT CAUSED BY A SECOND STRIKE? A CASE REPORT

Angioedema is characterized by swelling of the skin, mucosa, and submucosa, involving the deeper connective tissues. It can be triggered by allergic or non-allergic mechanisms, including the use of Angiotensin-Converting Enzyme Inhibitors (ACE-Is). SARS-CoV-2 has also been associated with angioedema, although the underlying mechanism remains poorly understood. This case report presents a middle-aged Caucasian woman who tested positive for SARS-CoV-2 and subsequently developed angioedema, along with impaired consciousness, acute respiratory acidosis, and severe respiratory distress requiring intensive care unit admission and mechanical ventilation. The patient had been on long-term ACE-Is for hypertension. High-resolution computed tomography revealed SARS-CoV-2 interstitial pneumonia. While the angioedema resolved within 48-72 hours, the patient's clinical improvement was attributed to the administration of corticosteroid therapy, anticoagulant drugs, and oxygen therapy, allowing for successful weaning from mechanical ventilation and resolution of respiratory failure and interstitial pneumonia. The exact cause of angioedema in this patient remains unclear, as it could be attributed to ACE-Is as a known side effect, SARS-CoV-2 infection as an unusual manifestation, or a potential interaction between the two. This case underscores the need for further research to elucidate the interplay between SARS-CoV-2 and ACE-Is in the context of angioedema development.