LAUSR

A 44-year-old Caucasian female presented to an Emergency Department (ED) of a large metropolitan hospital with a one-day history of severe abdominal pain after commencing oral perindopril the day prior. Her medical history included hypertension and a laparoscopic appendicectomy. She had no medication allergies, and no travel history, dietary or environmental exposure of concern. She was commenced on oral perindopril 4 mg daily by her family doctor for hypertension. After an hour of taking the first dose of perindopril, she began feeling extremely lethargic. The next morning, after 30 min of taking the second dose, she developed intermittent non-radiating abdominal cramps. By the afternoon, she felt nauseated, vomited five times and had one episode of non-bloody diarrhoea. Her abdominal pain progressed to severe grade, which prompted her to present to ED. On the initial examination, she was afebrile and appeared well. There were no skin rashes, lip or tongue swelling. Her abdomen was soft with generalised tenderness, most pronounced in the central abdomen. Her white cell count was mildly elevated at 12.7 10/L. The rest of her blood counts, serum electrolytes and renal and liver function tests were normal. Beta hCG was negative. Computed tomography (CT) of the abdomen and pelvis showed moderate ascites and bowel wall thickening with submucosal oedema about the duodenum and proximal jejunum. There was mild oedema of the small bowel mesentery (Fig. 1).