An encounter with enalapril-induced resistant, life-threatening angioedema at rural health center in Botswana

Angioedema, a rare, potentially fatal and usually self-limiting adverse effect of therapy with enalapril, is always a challenging encounter for an intensive care specialist in a rural setup. Here, we present a 74-year-old female, who presented to the Emergency Department of Sekgoma Memorial Hospital, Serowe village, Botswana, with progressive swelling of her face, tongue and breathing difficulty just 2 days after starting tablet enalapril. She failed to respond to usual treatment with adrenaline, steroids, and H1-antihistaminic agent, but she responded well with intravenous fresh-frozen plasma infusion. This helped us manage a difficult airway situation in a less equipped rural health center.