Dear editor,rnAccording to the World Health Organization, ischemic heart disease and stroke were the top 2 leading causes of death in 2019.[1] In the past few years, intravenous recombinant tissue-type plasminogen activator (rt-PA) has been a significantly effective treatment to increase survival and reduce mortality in acute ischemic stroke.[2,3] However, as the number of patients who receive alteplase is increasing, a rare but potentially life-threatening adverse complication of alteplase administration is becoming more common—orolingual angioedema (OA).[4-6] OA is acute swelling of the tongue, lips or face and may be life-threatening, as it can increase the risk of upper airway obstruction. Some studies have found that angiotensin-converting enzyme (ACE) inhibitors could increase the risk of OA caused by rt-PA intravenous thrombolysis, which is related to an anaphylactoid reaction.[5-7] However, it has also presented in acute stroke patients not taking these medications. The rt-PA-related OA has rarely been reported in Asian countries, especially in China. Herein, we report a case of an elderly Chinese man who experienced OA after thrombolysis in emergency conditions, which might have been caused both by acute hypersensitivity and anaphylactoid reactions. We suggest that increased attention should be given during or after alteplase therapy.