Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4876-4882
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4876
Paliperidone palmitate-induced facial angioedema: A case report
Maytinee Srifuengfung, Thanisorn Sukakul, Chanika Liangcheep, Natee Viravan
Maytinee Srifuengfung, Chanika Liangcheep, Natee Viravan, Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Thanisorn Sukakul, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Srifuengfung M designed the report; Liangcheep C was the patient’s physician, collected the patient’s data, and reviewed the literature; Sukakul T interpreted the clinical data and image findings; Srifuengfung M, Sukakul T, and Viravan N reviewed the literature and wrote the manuscript; all authors were responsible for the revision of the manuscript; and all authors approved the final version for publication.
Informed consent statement: Informed written consent was obtained from the patient’s legally authorized representative for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Natee Viravan, FRCP, MD, Doctor, Lecturer, Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand. natee.vir@mahidol.ac.th
Received: June 6, 2020
Peer-review started: June 6, 2020
First decision: September 13, 2020
Revised: September 15, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 26, 2020
Processing time: 141 Days and 18.2 Hours
Abstract
BACKGROUND

Paliperidone palmitate is a once-monthly injectable, atypical antipsychotic. To our knowledge, there has been only one report of paliperidone palmitate-induced angioedema presenting with acute laryngeal edema with subsequent respiratory arrest. Here, we present a case report of paliperidone palmitate-induced angioedema with a relatively mild clinical presentation compared with the previously reported case, and the patient’s condition was not complicated by life-threatening anaphylaxis.

CASE SUMMARY

A 79-year-old female, who had a major neurocognitive disorder due to Alzheimer’s disease with behavioral disturbances. Paliperidone palmitate was off-label used to control her aggression, irritability, and psychosis. After induction doses (150 mg and 100 mg intramuscularly, given 1 wk apart), she developed intermittent swelling of the face, eyelids, and lips on day 17 after the initial dose, and the edema was explicitly seen on day 20. The diagnosis was paliperidone palmitate-induced angioedema. The monthly injection dose was discontinued on day 33 after the initial dose. The angioedema was subsequently alleviated, and it had completely resolved by day 40 after the initial dose.

CONCLUSION

Paliperidone palmitate-induced angioedema is a rare condition and can present with a mild, intermittent facial edema, which may be overlooked in clinical practice.

Keywords: Case report; Paliperidone palmitate; Paliperidone LAI; Long-acting paliperidone; Angioedema

Core Tip: Paliperidone palmitate-induced angioedema can present with insidious onset, intermittent, facial edema which may be overlooked. Previous reports show that paliperidone-induced angioedema, which may cause life-threatening laryngeal edema, may be dose-related. This report raises awareness of this rare, adverse effect, angioedema. Close monitoring of patients should be performed when they are administered paliperidone palmitate, especially psychiatric patients who are unable to detect their illness.