Pulmonary medicine and critical care specialist Dr. Mike Hansen has been making YouTube videos throughout the pandemic in an effort to dispel medical disinformation and help people make informed decisions about their own health. In a recent video, he addresses an extremely rare side effect that has been exhibited by a small number of Covid patients: “Covid tongue.”
The medical term for this extreme swelling of the tongue is macroglossia, and first came to public attention after a stroke patient named Karen Washington woke up from a two-week coma, with a painfully enlarged tongue which prevented her from eating and drinking.
“Macroglossia is relatively rare, but it’s not unheard of,” says Hansen. “There are certain chronic conditions that can cause it.”
One such condition is ACE inhibitor-induced angiodema. ACE (angiotensin-converting-enzyme) inhibitors such as lisinopril, captopril, ramipril, and enalapril are drugs commonly prescribed to patients with high blood pressure. In an extremely low number of these patients, elevated levels of bradykinin, des-Arg9-bk and substance P can lead to dilation of the blood vessels if the body can’t break them down quickly enough, which causes swelling.
“When angiodema occurs as a result of these medications, it most commonly causes swelling of the lips, tongue and face,” says Hansen. “Swelling usually develops over minutes to hours, then peaks, and resolves within 24 to 72 hours, although complete resolution may take days in some cases.”
The reason some Covid patients also display macroglossia is due to also being on these inhibitors. Hansen cites the example of a cluster of cases which were all treated by the same doctor. In all nine cases, they were intubated (i.e. they were on a ventilator). Two of them had suffered strokes, while the other seven had been hospitalized due to Covid. Hansen presumes that all nine of these patients were prescribed ACE inhibitors, and speculates that the two stroke patients may have also had Covid.
“Covid binds to ACE2 receptors, and the tongue is lined with ACE2 receptors,” he says. “We know that when the virus binds to those receptors, it affects bradykinin levels.”
He adds that angiodema is currently thought to only affect between 0.1 and 0.7 percent of patients on ACE inhibitors, but that it is five times more likely to affect individuals of African descent. “It comes down to genetics. There are various genetic polymorphisms in certain enzymes which occur at a greater rate in African-Americans. These polymorphisms lead to lower circulating levels of these enzymes, which are responsible for degrading bradykinin.”
Ultimately, Hansen says, this strange, sometimes painful side effect of Covid treatment is just “one more reason to get the vaccine.”
Source: Read Full Article