Angioedema, ACE inhibitor and COVID-19

BMJ Case Rep. 2020 Sep 9;13(9):e237888. doi: 10.1136/bcr-2020-237888.


SARS-CoV-2, the virus responsible for COVID-19, binds to the ACE2 receptors. ACE2 is thought to counterbalance ACE in the renin-angiotensin system. While presently it is advised that patients should continue to use ACE inhibitors or angiotensin receptor blockers, questions still remain as to whether adverse effects are potentiated by the virus. Here, we report a case of a 57-year-old man, unknowingly with COVID-19, who presented to the emergency department with tongue swelling, shortness of breath and difficulty in speaking following 4 months taking benazepril, an ACE inhibitor. Finally, we also describe possible pathways that exist for SARS-CoV-2 to interact with the mechanism behind angioedema.

Keywords: emergency medicine; pneumonia (infectious disease); unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Angioedema / chemically induced*
  • Angioedema / complications*
  • Angioedema / drug therapy
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Anti-Allergic Agents / therapeutic use
  • Benzazepines / adverse effects*
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications*
  • Diagnosis, Differential
  • Diphenhydramine / therapeutic use
  • Famotidine / therapeutic use
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • SARS-CoV-2
  • Tranexamic Acid / therapeutic use


  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Allergic Agents
  • Benzazepines
  • Histamine H2 Antagonists
  • Famotidine
  • Tranexamic Acid
  • Diphenhydramine
  • benazepril