Background

The absolute risk of angiotensin-converting enzyme (ACE) inhibitor angioedema is 0.3 % [1]. The mechanism is felt to be accumulation of bradykinin. The current treatment is discontinuation of ACE-I inhibitor, and intubation if necessary. Icatibant is a bradykinin receptor antagonist, useful in treating hereditary angioedema [2]. We present a patient from a Canadian center who had ACE-inhibitor induced angioedema requiring intubation who did not respond to epinephrine or C1 esterase inhibitor concen-trate, then later responded favorably to Icatibant. Case presentation We present a case of a 76 year old male with hypertension, type II diabetes, no allergies, who was seen in the ER with acute new-onset tongue and facial swelling. He had a virus 2 weeks prior. His medications included quinapril, simvas