Angioedema from recombinant TPA administration: case report and pathophysiology review.

Angioedema is an uncommon, yet morbid, adverse reaction to recombinant tissue plasminogen activator (rtPA) administration for ischemic stroke. Orolingual edema may preclude completion of rtPA therapy and cause potential airway compromise. Few case reports and case series have examined the incidence of angioedema and anaphylaxis related to this common stroke therapy. We report a case of orolingual edema and bleeding in a patient who received rtPA for acute ischemic stroke who was concurrently on an angiotension-converting enzyme inhibitor and discuss the pathophysiology of this reaction.