Abstract
Background
Diltiazem in its extended-release formulation is widely prescribed and is generally
well-tolerated. Currently, there are no published case reports of localized inflammation
related to extended-release diltiazem causing either significant pill esophagitis
or airway inflammation when swallowed incompletely.
Case Report
We present a case of an 85-year-old female who reported difficulty swallowing roughly
18 h after incomplete ingestion of an extended-release diltiazem tablet. She had mild
stridor and visible right-sided neck swelling on examination. Imaging revealed a large
inflammatory mass, which was believed to be a subacute to chronic neoplastic process
when reviewed both by radiology and otolaryngology. Two days after presentation, however,
the patient's symptoms and the inflammatory mass had resolved entirely.
Why Should an Emergency Physician Be Aware of This?
Extended-release diltiazem can cause an inflammatory mass when ingested incompletely,
leading to possible acute airway compromise. Any invasive airway intervention should
be approached with caution, given the degree of acute inflammation. Even in patients
who do not require intervention, close observation until clinical improvement is warranted
in symptomatic patients with a history of recent incomplete ingestion of extended-release
diltiazem.
Keywords
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Reference
- Increased risk of esophageal obstruction with slow-release medications.J Assoc Acad Minor Phys. 1997; 8: 38-42
Article info
Publication history
Published online: April 19, 2020
Accepted:
March 18,
2020
Received in revised form:
February 10,
2020
Received:
September 11,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
