Saturday, September 30, 2023

An unusual cause of recurrent facial oedema

  1. Xin Luo, resident otolaryngologist1 2,
  2. Xiaohua Huang, otolaryngologist3,
  3. Jing Su, nurse2,
  4. Qintai Yang, consultant1 2
  1. 1Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  2. 2Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
  3. 3Department of Otolaryngology-Head and Neck Surgery, Dongguan Songshanhu Central Hospital, Dongguan, China
  1. Correspondence to Q Yang. yangqint{at}

A man in his early 20s presented to the otolaryngology emergency department with a 10 hour history of swelling affecting his face and left hand, with associated difficulty breathing. He had no associated rash or pruritus, and reported no clear precipitating factors. Physical examination revealed facial swelling (fig 1) and oedema of the tongue, soft palate, uvula, epiglottis, and vocal folds.

Fig 1

Acute exacerbation of angioedema

The patient had a two year history of recurrent swelling affecting the face and left hand. He had no family history of similar episodes. He had previously been identified as allergic to various food and inhalant allergens, but had never had anaphylactic reactions and did not report exposure to any of these allergens in the current presentation.

Despite lack of exposure to a known or probable allergen, the patient’s condition was managed as anaphylaxis because of the significant facial angioedema and dyspnoea, but with no significant improvement.

After acute management, further investigations of his complement pathway showed C1q 2 U/mL (normal range …

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