RESUMEN
C1-inhibitor deficiency is a rare disease which incorporates acute self-limiting intermittent swelling of the subcutaneous tissue and mucous membranes. Attacks most frequently affect the face and/or the upper airway. Isolated angioedema of the small bowel is an uncommon manifestation and often accompanied by diagnostic delay. In the present case, abdominal pain turned out to be the first and only utterance of an acquired C1-inhibitor deficiency, secondary to a splenic marginal zone lymphoma. Imaging showed wall thickening of the small intestine, ascites and splenomegaly. The abdominal pain and intestinal wall thickening with surrounding ascites on imaging spontaneously resolved each episode within 2-3 days. Gastrointestinal manifestations of angioedema may mimic an acute abdomen, and subsequently one-third of these patients undergo unnecessary surgery prior to a definite diagnosis. This emphasises the importance of considering the diagnosis in case of an 'extraordinary colic'.
Asunto(s)
Angioedema , Angioedemas Hereditarios , Cólico , Dolor Abdominal/complicaciones , Angioedema/diagnóstico por imagen , Angioedema/etiología , Angioedemas Hereditarios/complicaciones , Ascitis/complicaciones , Cólico/complicaciones , Proteínas Inactivadoras del Complemento 1 , Diagnóstico Tardío , HumanosRESUMEN
Isolated angioedema of the small intestine is a rare adverse event in patients taking angiotensin-converting enzyme inhibitors. Here, we present a case of visceral angioedema in a 32-year-old woman who presented with left upper quadrant pain, nausea, vomiting, diarrhea, and characteristic radiographic signs of small bowel angio-edema, six months after starting lisinopril. Her symptoms improved within 48 hours of withholding the offending agent and with supportive care. We discuss the epidemiology, pathophysiology, diagnosis, and management of angiotensin-converting enzyme inhibitor- induced angioedema.
Asunto(s)
Angioedema , Inhibidores de la Enzima Convertidora de Angiotensina , Dolor Abdominal , Adulto , Angioedema/inducido químicamente , Angioedema/diagnóstico por imagen , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antivirales , Diarrea , Femenino , Humanos , Intestino Delgado/diagnóstico por imagenRESUMEN
We present the case of a patient with small bowel angioedema induced by iodinated contrast media during computed tomography. It is important to know this entity and to differentiate it from other intestinal diseases in order to avoid inappropriate treatment.
Asunto(s)
Angioedema , Enfermedades Intestinales , Angioedema/inducido químicamente , Angioedema/diagnóstico por imagen , Medios de Contraste/efectos adversos , Humanos , Enfermedades Intestinales/inducido químicamente , Intestino Delgado , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To evaluate whether ultrasound can differentiate between cellulitis and angioedema from insect bites in pediatric patients. METHODS: A prospective, pre-post study in an urban pediatric emergency department of patients younger than 21 years with soft tissue swelling from insect bites without abscesses were enrolled. Treating physician's pretest opinions regarding the diagnosis and need for antibiotics were determined. Ultrasound of the affected areas was performed, and effects on management were recorded. Further imaging, medications, and disposition were at the discretion of the enrolling physician. Phone call follow-ups were made within a week of presentation. RESULTS: Among 103 patients enrolled with soft tissue swelling secondary to insect bites, ultrasound changed the management in 27 (26%) patients (95% confidence interval [CI], 18-35%). Of the patients who were indeterminate or believed to require antibiotics, ultrasound changed management in 6 (23%) of 26 patients (95% CI, 6%-40%). In those patients who were believed not to require antibiotics, ultrasound changed management in 12 (16%) 77 patients (95% CI, 7%-24%). Patients with diagnosis of local angioedema achieved symptom resolution 1.4 days sooner than patients diagnosed with cellulitis (mean, -1.389; 95% CI, -2.087 to -0.690; P < 0.001). No patient who was initially diagnosed as local angioedema received antibiotics upon patient follow-up. CONCLUSIONS: Point-of-care ultrasound changed physician management in 1 of 4 patients in the pediatric emergency department with soft tissue swelling secondary to insect bites. Ultrasound may guide the management in these patients and lead to improved antibiotic stewardship in conjunction with history and physical examination.
Asunto(s)
Angioedema , Infecciones de los Tejidos Blandos , Angioedema/diagnóstico por imagen , Angioedema/tratamiento farmacológico , Celulitis (Flemón)/diagnóstico por imagen , Celulitis (Flemón)/tratamiento farmacológico , Niño , Servicio de Urgencia en Hospital , Humanos , Sistemas de Atención de Punto , Estudios Prospectivos , UltrasonografíaAsunto(s)
Angioedema/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Enfermedades del Yeyuno/inducido químicamente , Lisinopril/efectos adversos , Angioedema/diagnóstico por imagen , Angioedema/patología , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Femenino , Humanos , Enfermedades del Yeyuno/diagnóstico por imagen , Enfermedades del Yeyuno/patología , Lisinopril/administración & dosificación , Adulto JovenAsunto(s)
Angioedema/inducido químicamente , Fibrinolíticos/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Angioedema/diagnóstico por imagen , Femenino , Fibrinolíticos/administración & dosificación , Enfermedades Gastrointestinales/diagnóstico por imagen , Humanos , Accidente Cerebrovascular/diagnóstico , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del TratamientoRESUMEN
Although immune checkpoint inhibitors improve survival in cancer patients, they have also been linked with unusual side effects. The most common side effects of these agents are immune-mediated phenomena such as itching, skin rash, arthralgias, mild transaminitis and asymptomatic thyroid dysfunction. We describe herein a case of facial angioedema occurring 20 weeks after initiating adjuvant nivolumab therapy for melanoma. The patient had full resolution of symptoms with cessation of nivolumab and a short steroid course. As the causality of an association between nivolumab and angioedema seems legitimate, we expect further similar cases to surface in patients treated with immune checkpoint inhibitors. Prompt drug withdrawal and steroids are crucial to ensure favorable clinical outcomes in these patients.
Asunto(s)
Angioedema/inducido químicamente , Angioedema/diagnóstico por imagen , Antineoplásicos Inmunológicos/efectos adversos , Melanoma/diagnóstico por imagen , Melanoma/tratamiento farmacológico , Nivolumab/efectos adversos , Anciano de 80 o más Años , Antineoplásicos Inmunológicos/administración & dosificación , Exantema/inducido químicamente , Exantema/diagnóstico por imagen , Humanos , Masculino , Nivolumab/administración & dosificación , Factores de TiempoRESUMEN
ACE inhibitors (ACEi) are common anti-hypertensive drugs that can cause angioedema. Though classic, or facial angioedema is rare, visceral angioedema is even less common. When angioedema occurs, it typically presents early, within 30 days of initiating therapy. Visceral angioedema most commonly presents with nausea, emesis, abdominal pain and diarrhoea, and thus is often mistaken for an episode of gastroenteritis. When a CT scan is obtained, it typically shows characteristic findings, including ascetic fluid, mild mesenteric oedema and thickening of the small bowel. In this case report, we present a patient who did not experience her first episode of visceral angioedema until after she had been on ACEi therapy for 5-7 years. In addition, she experienced recurrent episodes of visceral angioedema that were separated by approximately 4 years at a time. Both of these features make for a particularly unique presentation.
Asunto(s)
Angioedema/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Lisinopril/efectos adversos , Vísceras/patología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Angioedema/diagnóstico por imagen , Angioedema/tratamiento farmacológico , Antialérgicos/uso terapéutico , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Femenino , Glucocorticoides/uso terapéutico , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/etiología , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Background and Purpose- Oral angioedema (OA) is a rare but life-threatening complication in patients with ischemic stroke receiving intravenous thrombolysis with r-tPA (recombinant tissue-type plasminogen activator). This study intended to determine associations between thrombolysis-related OA and ischemic stroke lesion sites using a voxel-wise lesion analysis. Methods- Prospective registry data were used to identify ischemic stroke patients with thrombolysis-related OA between 2002 and 2018. For the study registry, ethics approval was obtained by the Ethics Committee of the Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg (clinical registry registration: 377_17Bc). Ischemic stroke patients with thrombolysis treatment but without OA admitted in the years 2011 and 2012 comprised the control group. Ischemic lesions were manually outlined on magnetic resonance imaging (1.5T or 3T) or computed tomographic scans and transformed into stereotaxic space. We determined the lesion overlap and compared the absence or presence of OA voxel-wise between patients with and without lesions in a given voxel using the Liebermeister test. Stroke severity was rated using the National Institutes of Health Stroke Scale score, and blood pressure, heart rate, blood glucose levels, and body temperature were determined on admission. Results- Fifteen ischemic stroke patients with thrombolysis-related OA were identified. The voxel-wise analysis yielded associations between OA and ischemic lesions in the insulo-opercular region with a right hemispheric dominance. Mean blood pressure was significantly lower in patients with OA than in controls. Age, National Institutes of Health Stroke Scale scores, infarct volumes, heart rate, and blood glucose levels did not differ between patients with and without OA. Conclusions- The voxel-wise analysis linked thrombolysis-related OA to right insulo-opercular lesions. The lower blood pressure in patients with thrombolysis-related OA may reflect bradykinin effects causing vasodilatation and increasing vascular permeability.
Asunto(s)
Angioedema/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Terapia Trombolítica/efectos adversos , Anciano , Anciano de 80 o más Años , Angioedema/diagnóstico por imagen , Presión Sanguínea , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/terapia , Mapeo Encefálico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/diagnóstico por imagen , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía Computarizada por Rayos XAsunto(s)
Angioedema/inducido químicamente , Antagonistas de Receptores de Angiotensina/efectos adversos , Úvula , Angioedema/diagnóstico por imagen , Angioedema/tratamiento farmacológico , Diagnóstico Diferencial , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
An 85-year-old woman was transported to our emergency room by ambulance with a complaint of slurred speech. Neurological examination revealed dysarthria only. We considered that lingual edema identified on physical examination might have influenced dysarthria. However, we were unable to perform sufficient evaluation, since she could not open her mouth widely or push the tongue out beyond the lips. We considered the incidence of acute cerebrovascular disease because of the acute onset, and performed emergency brain MRI. Imaging revealed that although no abnormality was present in the brain parenchyma, edema of the tongue and soft palate was evident on T2-weighted sagittal imaging. We confirmed the dysarthria was caused by tongue edema due to angioedema. In addition, we diagnosed angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema, because ACEI had been started 2 months earlier as pharmacotherapy for hypertension. Tongue swelling due to angioedema should be considered when examining patients with dysarthria.
Asunto(s)
Angioedema/inducido químicamente , Angioedema/complicaciones , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Disartria/etiología , Enfermedades de la Lengua/inducido químicamente , Enfermedades de la Lengua/complicaciones , Anciano de 80 o más Años , Angioedema/diagnóstico por imagen , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Diagnóstico Diferencial , Imagen de Difusión Tensora , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Ataque Isquémico Transitorio , Enfermedades de la Lengua/diagnóstico por imagenAsunto(s)
Angioedema/inducido químicamente , Medios de Contraste/efectos adversos , Enfermedades Intestinales/inducido químicamente , Intestino Delgado/diagnóstico por imagen , Meglumina/análogos & derivados , Compuestos Organometálicos/efectos adversos , Administración Intravenosa , Adulto , Angioedema/diagnóstico por imagen , Humanos , Enfermedades Intestinales/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Meglumina/efectos adversosRESUMEN
In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.
Asunto(s)
Angioedema/diagnóstico , Antihipertensivos/efectos adversos , Hipertensión , Enfermedades del Íleon/diagnóstico , Lisinopril/efectos adversos , Insuficiencia Renal Crónica , Dolor Abdominal/etiología , Adulto , Angioedema/inducido químicamente , Angioedema/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Enfermedades del Íleon/inducido químicamente , Enfermedades del Íleon/diagnóstico por imagen , Masculino , Tomografía Computarizada por Rayos XRESUMEN
A Rare Cause of an Angioedema-Like Habitus Abstract. We report about a 69-year-old patient arriving at the emergency room with suspected allergic reaction grade III due to a pronounced facial swelling, dyspnea and dizziness. However, the cause was a bilateral pneumothorax with massive soft-tissue emphysema. On the one side it was due to a spontaneous secondary genesis in the context of a chronic pulmonary disease, on the other side it was due to a traumatic serial rib fracture.
Asunto(s)
Angioedema/etiología , Servicio de Urgencia en Hospital , Enfisema Mediastínico/diagnóstico por imagen , Neumotórax/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Fracturas de las Costillas/diagnóstico por imagen , Enfisema Subcutáneo/diagnóstico por imagen , Anciano , Angioedema/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Tomografía Computarizada por Rayos XAsunto(s)
Dolor Abdominal/etiología , Angioedema/etiología , Linfocitos B , Diarrea/etiología , Linfocitosis/complicaciones , Dolor Abdominal/sangre , Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/terapia , Anciano , Angioedema/sangre , Angioedema/diagnóstico por imagen , Antiinfecciosos/uso terapéutico , Clostridioides difficile/aislamiento & purificación , Colonoscopía , Diarrea/sangre , Diarrea/diagnóstico por imagen , Diarrea/terapia , Enterocolitis Seudomembranosa/diagnóstico por imagen , Enterocolitis Seudomembranosa/microbiología , Enterocolitis Seudomembranosa/terapia , Trasplante de Microbiota Fecal , Femenino , Humanos , Intestino Delgado/irrigación sanguínea , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/microbiología , Intestino Delgado/patología , Síndrome del Colon Irritable/diagnóstico por imagen , Síndrome del Colon Irritable/microbiología , Síndrome del Colon Irritable/terapia , Linfocitosis/diagnóstico , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
El angioedema inducido por inhibidores de la enzima convertidora de angiotensina es una entidad poco frecuente caracterizada por edema en piel y mucosas, debido al aumento de la permeabilidad vascular provocada por la inhibición de la enzima convertidora y el subsiguiente aumento de la bradiquinina. De manera frecuente cursa con compromiso facial y de mucosas, siendo infrecuente el compromiso intestinal o de vía aérea. El angioedema intestinal puede presentarse asociado a angioedema facial o aislado, siendo este último excepcional. Cursa con episodios recurrentes de dolor, distensión abdominal y diarrea acuosa con recuperación completa en dos o tres días. Si bien es una entidad poco frecuente, el hecho de que esté asociada a fármacos utilizados con frecuencia nos hace incluirla en el diagnóstico diferencial del dolor abdominal recurrente. Presentamos un caso de angioedema intestinal aislado, asociado al uso de enalapril.
Angioedema induced by angiotensin converting enzyme inhibitors is a rare entity characterized by skin and mucosal edema, due to increased vascular permeability caused by inhibition of the converting enzyme and subsequent increase in bradykinin. It frequently presents with facial and mucosal involvement, being uncommon the intestinal or airway compromise. Intestinal angioedema may be associated with facial or isolated angioedema, the latter being exceptional. It is associated with recurrent episodes of pain, abdominal distention and watery diarrhea which complete recovery in two or three days. Although it is a rare entity, the fact that it is associated with frequently used drugs makes us include it in the differential diagnosis of recurrent abdominal pain. We report a case of isolated intestinal angioedema associated with the use of enalapril.
Asunto(s)
Humanos , Femenino , Anciano , Enalapril/efectos adversos , Enfermedades Intestinales/inducido químicamente , Angioedema/inducido químicamente , Antihipertensivos/efectos adversos , Hipertensión/tratamiento farmacológico , Enfermedades Intestinales/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Angioedema/diagnóstico por imagenRESUMEN
Angioedema induced by angiotensin converting enzyme inhibitors is a rare entity characterized by skin and mucosal edema, due to increased vascular permeability caused by inhibition of the converting enzyme and subsequent increase in bradykinin. It frequently presents with facial and mucosal involvement, being uncommon the intestinal or airway compromise. Intestinal angioedema may be associated with facial or isolated angioedema, the latter being exceptional. It is associated with recurrent episodes of pain, abdominal distention and watery diarrhea which complete recovery in two or three days. Although it is a rare entity, the fact that it is associated with frequently used drugs makes us include it in the differential diagnosis of recurrent abdominal pain. We report a case of isolated intestinal angioedema associated with the use of enalapril.
Asunto(s)
Angioedema/inducido químicamente , Antihipertensivos/efectos adversos , Enalapril/efectos adversos , Enfermedades Intestinales/inducido químicamente , Anciano , Angioedema/diagnóstico por imagen , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Enfermedades Intestinales/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagenRESUMEN
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