Angioedema of the small bowel caused by angiotensin converting enzyme inhibitor

A 69-year-old male with a previous history of atrial fibrillation and hypertension was admitted to the emergency department because of acute onset of abdominal pain, accompanied by distension, nausea and diarrhea. Physical examination was unremarkable except for diffuse abdominal tenderness on palpation without rebound or guarding. Normoactive bowel sounds were noted. Routine blood analysis showed elevated C-reactive protein 12.8 mg/dl (normal values 0.1-1.0) and INR of 3.1 (normal values 0.9-1.2 – therapeutic values 2.0-3.0). Patient was treated for atrial fibrillation with anticoagulation therapy. Hypertension was treated with beta-blocker and angiotensin-converting enzyme inhibitor Lisinopril SandozR for 10 days.