(424) Empagliflozin-Induced Angioedema in an Elderly Female: A Case Report

Introduction: Angioedema is a potentially life-threatening condition characterized by the rapid onset of localized swelling, often involving the lips, tongue, or throat. While it is commonly associated with allergic reactions and certain medications, it can also occur idiosyncratically. Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor has not been widely reported as a cause of angioedema.

Description: An 84-year-old female with a history of HFpEF and no prior allergies presented with recurrent episodes of lip and tongue swelling beginning in May 2024. Medications include losartan, which she had been taking for over 40 years without adverse effects, and empagliflozin, which was added to her regimen in March 2024. The first episode of angioedema self-resolved without intervention. In early June 2024, she experienced a second episode and sought emergency care. She was treated with steroids, and losartan was discontinued. Despite this intervention, she had two more episodes of similar symptoms, prompting in an intensive care unit (ICU) admission for observation. Comprehensive diagnostic tests, including C1 esterase inhibitor levels, C4, C1q, and tryptase, were all within normal limits, ruling out hereditary and acquired forms of angioedema. After discontinuing empagliflozin, the patient reported no further episodes of swelling, suggesting a probable link between the medication and her symptoms.

Discussion: This case underscores the importance of considering empagliflozin as a potential cause of angioedema, even though it is not commonly associated with this adverse effect. The patient's negative results for typical angioedema-related tests, combined with the cessation of symptoms following the discontinuation of empagliflozin, suggest an idiosyncratic reaction to the medication. Angioedema can present without accompanying respiratory distress or other common allergic manifestations, as seen in this patient. Clinicians should maintain a high index of suspicion for drug-induced angioedema in patients presenting with unexplained swelling, particularly when new medications have been recently introduced. Further research into the mechanisms of SGLT2 inhibitor-induced angioedema is warranted to better understand and mitigate this risk. AI was used only minimally to assist in drafting this.