Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 1 2026 01 01 102 107 Alireza Shakeri Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Seyed Mohammad Seyed Alshohadaei Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 02 03 2025 02 08 Spinal anesthesia with bupivacaine is widely used for cesarean sections but can rarely cause angioedema, a rapid swelling of deep tissues that may lead to airway obstruction. This case report presents the occurrence of angioedema in a pregnant woman with postoperative hyper IgE levels following spinal anesthesia. It highlights the intricate interplay between drug sensitivity, immune dysregulation, and the physiological changes associated with pregnancy. We present a case of a 32-year-old woman with post-operative hyper IgE levels who developed angioedema shortly after getting spinal anesthesia with bupivacaine for a cesarean section. It should be noted that the patient had no prior history of allergic reactions, making the case particularly interesting and challenging. This report's goal is to: 1. Report details of the clinical presentation, management, and outcome of this unusual patient; 2. Investigate the potential etiologies of angioedema, with a focus on the relationship between bupivacaine sensitivity, hyper IgE, and other possible factors; and 3. Highlight the challenges in diagnosis and management when facing angioedema in patients with atypical presentations. https://aacc.tums.ac.ir/index.php/aacc/article/view/1195