Isolated tongue angioedema after alteplase infusion in acute ischemic stroke

Background: Angioedema, like anaphylaxis, has been reported as a rare adverse event of alteplase infusion in acute ischemic stroke. Objective: We report the case of a patient with acute ischemic stroke who after treatment of alteplase developed angioedema. Methods: We report the case of an 81-year-old woman who presented to our observation with acute ischemic stroke. The patient was on therapy with 100 mg acetylsalicylic acid and a triple combination antihypertensive drug (perindopril 10 mg + 2.5 mg indapamide + 5 mg amlodipine). The patient was treated with alteplase infusion. Results: Five minutes after the end of the alteplase infusion (0.9 mg/kg for 1 hour) the patient developed isolated angioedema of the lips and tongue. Conclusion: Although the incidence of alteplase-induced angiodema in these patients is rare, this case report suggests the need for routine inspection of the tongue in acute ischemic patient in treatment with alteplase infusion, especially in female patients in treatment with ACE inhibitors.