一例使用ACEI引起的腮腺反复肿胀病例

这是发表在Otolaryngol Head Neck Surg上的一个病例报道¹。ACEI的一个副作用是引起血管性水肿（Angioedema），可发生于面部及呼吸道。这个病例中的白人妇女的却表现为反复的腮腺肿胀，较为少见。

使用GPT-4对原文总结如下：

1. Brief Summary:
   The paper explores a case of recurrent intermittent parotid gland swelling associated with ACE Inhibitor (angiotensin-converting enzyme inhibitor) usage, a class of medication typically used for hypertension and congestive heart failure. Angioedema, an adverse effect characterized by swelling due to fluid accumulation in tissues, is a known, albeit rare, side effect of ACE inhibitors. This study is significant as it highlights a unique presentation of angioedema localized to the parotid gland, a condition not typically associated with ACE inhibitor use.

2. Key Findings and Methods:
   The paper presents the case of a 49-year-old woman experiencing recurrent, painless, unilateral parotid gland swelling. Initially thought to be sialadenitis, her condition improved only after discontinuing the ACE inhibitor, suggesting that the swelling was a manifestation of ACE inhibitor-induced angioedema. This connection was previously unrecognized, as angioedema usually presents more broadly or involves different areas such as the face or airways leading to potentially fatal airway compromise. The authors used patient history, clinical observations, and response to treatment alteration (discontinuation of the ACE inhibitor) to identify the cause of her symptoms. This case emphasizes the importance of considering drug-induced angioedema in recurrent parotid swelling cases and adds to the spectrum of clinical presentations for ACE inhibitor side effects.

患者出现腮腺反复肿胀后的诊疗和用药史如下：

The treatment history of the woman presented in the paper involves various attempts to address her recurrent parotid gland swelling with different medications and approaches. Here is the sequence of treatments she underwent:

1. Initial Treatment for Upper Respiratory Infection:

   • The patient first noticed swelling around her right parotid gland, which was initially thought to be related to an upper respiratory infection. Her only significant medical history was hypertension, managed with hydrochlorothiazide and an ACE inhibitor, ramipril.

2. Antibiotic Treatments:

   • Upon recurring swelling, she was treated with a series of antibiotics:
     • Amoxicillin: Initially showed response but the swelling recurred.
     • Ciprofloxacin and a decongestant: Temporary resolution of swelling.
     • Augmentin: Prescribed after a CT scan suggested chronic parotitis. The patient was also prepared for a superficial parotidectomy, but the surgery was delayed due to swelling resolution.
     • Clindamycin: Added later to the regimen without changing the course or presentation of her episodes.
   • Despite these treatments, the swelling kept recurring, suggesting that the underlying cause was not being addressed.

3. Change in Hypertension Medication:

   • Given the transient nature of her symptoms and lack of infection or long-term response to antibiotics, the medical team considered the possibility of ACE inhibitor-induced angioedema.
   • The hypertensive regimen was altered to exclude ACE inhibitors.
   • Following the discontinuation of the ACE inhibitor, the patient returned to the clinic 4 weeks later with no further episodes of parotid swelling and remained symptom-free for over 8 months after discontinuing the ACE-I.

The key outcome of this treatment history is that the patient’s recurrent parotid gland swelling was resolved following the discontinuation of the ACE inhibitor, suggesting that the swelling was indeed a manifestation of ACE inhibitor-induced angioedema.

在考虑到可能是ACEI导致的血管性水肿之前的多次治疗中，抗生素是有效的，但是停药后即复发，且其复发频率较慢性复发性腮腺炎的频率更高，曾经一次复发是肿胀范围超出了腮腺到达鼻翼旁的软组织。

1. Moss JR, Zanation AM, Shores CG. ACE inhibitor associated recurrent intermittent parotid gland swelling. Otolaryngol Head Neck Surg. 2005 Dec;133(6):992-4. doi: 10.1016/j.otohns.2004.12.007. PMID: 16360530. ↩