{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:23:23Z","timestamp":1783113803367,"version":"3.54.6"},"reference-count":18,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,30]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>A potential complication after intravenous administration of recombinant tissue plasminogen activators (rtPAs) for thrombolysis in acute ischaemic stroke is orolingual angioedema, with an incidence of 0.4%\u20137.9%. In the herewith reported case, we discuss potential links between a history of sarcoidosis and the occurrence of orolingual angioedema after rtPA administration. Sarcoidosis is often accompanied by an elevated ACE level. In contrast, low ACE levels appear to play a role in the pathomechanism currently assumed to trigger angioedema, that is, the activation of the bradykinin and complement pathways. Medication with ACE inhibitors is considered a risk factor for angioedema. Based on these considerations, the patient was also treated with icatibant, a bradykinin B2-receptor antagonist, which has been found useful in recent publications on treating orolingual angioedema after intravenous lysis in ischaemic stroke.<\/jats:p>","DOI":"10.1136\/bcr-2020-236643","type":"journal-article","created":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T18:18:21Z","timestamp":1608661101000},"page":"e236643","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Unilateral orolingual angioedema in a patient with sarcoidosis after intravenous thrombolysis due to acute stroke without improvement after treatment with icatibant"],"prefix":"10.1136","volume":"13","author":[{"given":"Anna Daniela","family":"Wollmach","sequence":"first","affiliation":[{"name":"Emergency Medicine, Cantonal Hospital of Baden, Baden, Aargau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Zehnder","sequence":"additional","affiliation":[{"name":"Internal Medicine, Cantonal Hospital of Baden, Baden, Aargau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Schwendinger","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Cantonal Hospital of Baden, Baden, Aargau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6984-6958","authenticated-orcid":false,"given":"Alexander Andrea","family":"Tarnutzer","sequence":"additional","affiliation":[{"name":"Neurology, Cantonal Hospital of Baden, Baden, Aargau, Switzerland"},{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,21]]},"reference":[{"key":"2025082711435495000_13.12.e236643.1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000058840.66596.1A"},{"key":"2025082711435495000_13.12.e236643.2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-308097"},{"key":"2025082711435495000_13.12.e236643.3","doi-asserted-by":"publisher","DOI":"10.1179\/1743132813Y.0000000302"},{"key":"2025082711435495000_13.12.e236643.4","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.013334"},{"key":"2025082711435495000_13.12.e236643.5","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2147\/IJGM.S112430","article-title":"Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study","volume":"9","author":"Sadeghi-Hokmabadi","year":"2016","journal-title":"Int J Gen Med"},{"key":"2025082711435495000_13.12.e236643.6","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1007\/s10072-018-3512-1","article-title":"Incidence of orolingual angioedema after intravenous thrombolysis for stroke","volume":"39","author":"Censori","year":"2018","journal-title":"Neurol Sci"},{"key":"2025082711435495000_13.12.e236643.7","first-page":"784","article-title":"Trombolysis in acute stroke","volume":"8","author":"Schwammenthal","year":"2006","journal-title":"Isr Med Assoc J"},{"key":"2025082711435495000_13.12.e236643.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-005-0789-9"},{"key":"2025082711435495000_13.12.e236643.9","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1080\/14737175.2018.1521723","article-title":"Select hyperacute complications of ischemic stroke: cerebral edema, hemorrhagic transformation, and orolingual angioedema secondary to intravenous alteplase","volume":"18","author":"Bar","year":"2018","journal-title":"Expert Rev Neurother"},{"key":"2025082711435495000_13.12.e236643.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.02.019"},{"key":"2025082711435495000_13.12.e236643.11","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.09.039","article-title":"Icatibant as a potential treatment of life-threatening alteplase-induced angioedema","volume":"27","author":"Cheong","year":"2018","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2025082711435495000_13.12.e236643.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2014.01.035"},{"key":"2025082711435495000_13.12.e236643.13","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.chest.2016.09.009","article-title":"Association of sarcoidosis with increased risk of VTe: a population-based study, 1976 to 2013","volume":"151","author":"Ungprasert","year":"2017","journal-title":"Chest"},{"key":"2025082711435495000_13.12.e236643.14","first-page":"284","article-title":"Angiotensin converting enzyme I\/D polymorphism and sarcoidosis risk","volume":"32","author":"Yang","year":"2016","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"2025082711435495000_13.12.e236643.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.07.045"},{"key":"2025082711435495000_13.12.e236643.16","doi-asserted-by":"crossref","first-page":"1125.e1","DOI":"10.1016\/j.ajem.2018.03.018","article-title":"Icatibant for the treatment of orolingual angioedema following the administration of tissue plasminogen activator","volume":"36","author":"Brown","year":"2018","journal-title":"Am J Emerg Med"},{"key":"2025082711435495000_13.12.e236643.17","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1111\/joim.12962","article-title":"Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study","volume":"286","author":"Vigneron","year":"2019","journal-title":"J Intern Med"},{"key":"2025082711435495000_13.12.e236643.18","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1212\/WNL.0000000000004834","article-title":"Orolingual and abdominal angioedema post thrombolysis and thrombectomy","volume":"90","author":"Benoit","year":"2018","journal-title":"Neurology"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-236643","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:44:03Z","timestamp":1756320243000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-236643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,21]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bcr-2020-236643"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-236643","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}