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Abstract
A woman in her 50s with a history of splenic marginal zone lymphoma developed severe angio-oedema after a scaling and root planing dental procedure. She was seen by multiple physicians who treated her for presumed local anaesthetic allergy and subsequently referred her to an academic allergy centre for specialised drug allergy testing. On evaluation, her clinical history was suggestive of acquired angio-oedema, which was confirmed by bloodwork. This case report underscores key clinical pearls that should prompt clinicians to consider a diagnosis of acquired angio-oedema, a rare bradykinin-mediated disease which can present with acute life-threatening angio-oedema and for which a clinical diagnosis is critical to selecting the appropriate acute therapy. The case also highlights the utility of a complement C4 test when patients present acutely with angio-oedema of unknown aetiology, especially in the emergency department.
- Allergy
- Hypersensitivity
Footnotes
Contributors JL, MM, LE, FIH and APB were responsible for drafting the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. JL, MM, LE, FIH and APB gave final approval of the manuscript. APB is the guarantor.
Funding This study was funded by the Yale Physician Scientist Development Award and CTSA Grant (UL1 TR001863).
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests FIH has received consultancy fees from CSL Behring, Intellia Therapeutics and KalVista Pharmaceuticals. The remaining authors declare no competing financial interests.
Provenance and peer review Not commissioned; externally peer reviewed.