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JOHN MCCABE, M.D., FACEP, is Professor and Chair, Department of Emergency Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse. CHRISTINE STORK, PHARMD., DABAT,. is Associate Professor, Department of Emergency Medicine, SUNY Upstate Medical University, and Clinical Director, Upstate New York Poison Center, Syracuse. DANIELLE MAILLOUX, M.D., is Instructor, Mt. Sinai School of Medicine, Department of Emergency Medicine, and Attending Physician, Queens Hospital Center, Jamaica, NY. MARK SU, M.D., FACEP, FACMT, is Assistant Professor of Emergency Medicine and Director, Fellowship in Medical Toxicology, Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY; at the time of writing he was Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, and Assistant Professor, Kings County Hospital Center, Brooklyn.

Address correspondence to Dr. Stork at the Upstate New York Poison Center, 750 East Adams Street, Syracuse, NY 13210 (storkc{at}upstate.edu).

Purpose. Two cases of penile angioedema associated with the use of angiotensin-converting-enzyme inhibitors and angio-tensin II receptor blockers are reported. Summary. The first case of penile angioe-dema involved a 68-year-old man who arrived at the emergency department (ED) with a 2–12-hour history of penile swelling occurring three days after initiation of irbesartan in addition to longstanding lisinopril therapy. All parts of the physical examination were normal, except for the genital examination. The patient’s penis was edematous at midshaft only and was nontender with normal skin coloring. The edema was nonpitting and limited to the skin. The patient was instructed to stop taking both lisinopril and irbesartan, and symptoms resolved within 48 hours with supportive care alone. In the second case, a 48-year-old man arrived at the ED complaining of penile swelling over the previous two days. Enalapril had been initiated one month before his arrival at the ED. The patient’s penis was nontender and edematous at midshaft. The edema was nonpitting and limited to the skin. The patient was instructed to stop taking enalapril, given oral prednisone 60 mg, and asked to continue his prednisone for five days after discharge. The swelling resolved within two days of stopping enalapril, and he had no further episodes of penile swelling. Neither patient was rechallenged with the offending medications. Conclusion. Penile angioedema was reported in two patients. The first case involved a patient receiving both lisinopril and irbesartan. The second patient was receiving enalapril only. Index terms: Angioedema; Angiotensin antagonists; Angiotensin-converting-enzyme inhibitors; Enalapril; Irbesartan; Lisinopril; Prednisone; Steroids, cortico-; Toxicity