Acutely swollen tongue in a middle-aged woman.

Volume 82, Number 3 www.aafp.org/afp American Family Physician 279 A 55-year-old black woman presented to the emergency department with acute swelling of the tongue and mild respiratory distress. Her tongue began swelling about three hours earlier, and mild respiratory distress developed during the hour before presentation. She had a history of hypertension, diabetes mellitus, seizure disorder, and moderate mental retardation. She was taking aspirin, lisinopril (Zestril), metformin (Glucophage), phenobarbital, and doxazosin (Cardura), and there was no change in medications in the previous three years. She had no known medication or environmental allergies. Examination of the oral cavity revealed copious secretions and macroglossia (see accompanying figure). Respiratory examination showed rare crackles, but no wheezing.