Onset of angioedema following a viper bite: different options for diagnostic procedure in an emergency department

Riccardi, Alessandro; Minuto, Pierangela; Col, Anna Da; Panunzio, Viviana; Lerza, Roberto

doi:10.4081/ecj.2011.2.10

Cited by 1 publication

(3 citation statements)

References 13 publications

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“…Therefore, the observation of patients is important, in order to record any changes in the clinical picture. This is also important for angioedema 10 and, in our case, the observation allowed us to make the final diagnosis.…”

Section: Discussionsupporting

confidence: 55%

“…In fact, if tongue abscess is considered a very rare event indeed, 1-6 the same might be said for non-histaminergic angioedema, at least for those variants which are not related to angiotensinconverting enzyme inhibitors, as acquired or hereditary angioedema. [7][8][9][10] Non-allergic angioedema is characteristically cold, without major urticaria or pruritic edema, and moreover in our patient signs of inflammation as pain, fever, leucocytosis, redness of the skin and mucosal membranes, lymph nodes enlargement were substantially absent. 10 Then, on this basis, the diagnosis of acquired angioedema was possible, also given the lack of family history of similar episodes and the intake of specific drugs, in addition to the normal surface appearance of the lingual mucosa.…”

Section: Discussionmentioning

confidence: 90%

“…7-10 Non-allergic angioedema is characteristically cold, without major urticaria or pruritic edema, and moreover in our patient signs of inflammation as pain, fever, leucocytosis, redness of the skin and mucosal membranes, lymph nodes enlargement were substantially absent. 10 Then, on this basis, the diagnosis of acquired angioedema was possible, also given the lack of family history of similar episodes and the intake of specific drugs, in addition to the normal surface appearance of the lingual mucosa. No data led us to think of a tongue abscess.…”

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confidence: 99%

See 2 more Smart Citations

Tongue abscess: a rare occurrence possibly mimicking angioedema

Riccardi¹,

Dignetti²,

Tasso³

et al. 2013

Emerg Care J

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Despite the popularity of tongue piercing in recent years, the finding of a tongue abscess is considered extremely rare by international literature. The few available reports refer to a situation generally well documented objectively, posing problems of differential diagnosis for cancer, metastases, cysts, foreign bodies, intraparenchymal hemorrhage, macroglossia and edema of various origins. An acute enlargement of the tongue can be difficult to diagnose especially if there are no mucosal breaks or inflammation, and it may obstruct the upper airway and be a clinical challenge. Here we report a case observed in our emergency department which, at presentation, seemed suggestive for an angioedema. Case ReportA 51-year-old man was brought to our emergency department (ED) because, the night before his admission, he was showing dyslalia, dysphagia and tongue swelling, especially in the right half. His past history was inexpressive, and he did not report known allergies. He was not taking any drugs. The patient was afebrile, did not complain of any pain in his oral cavity, neither spontaneously nor to palpation of the tongue. There was no enlargement of submandibular and neck lymph nodes and the lingual mucosa did not show any alteration (Figure 1). All baseline blood tests were normal, except for a slight increase of C-reactive protein to 0.69 mg/dL (n.r. 0.05-0.3). In particular, the total and differential white blood cells counts were in the normal range. The consulted ear-nose-throat (ENT) professional noted slight edema on the right half of the tongue and on the floor of the mouth, and agreed with a provisional diagnosis of angioedema. Compared to the previous night the patient reported that his symptoms seemed to decrase, but nevertheless we gave 4 mg betamethasone and 10 mg clorphenamine parenterally. After a night under observation, the patient felt better and was discharged as his clinical picture seemed to have substantially improved. Two days later the patient returned to the ED, complaining of similar problems. This time his clinical picture was not particularly different from the previous one, except for a mild soreness of the tongue. The consulted ENT professional suggested again an angioedema since there were no changes in his lingual mucosa. This time, in addition to steroids and antihistamines, we administered Icatibant 1 f 30 mg subcutaneously and again we kept the patient under observation. The next morning he reported a partial improvement of his symptoms, however on the upper side of the tongue a small pustule had appeared. A large amount of pus came out after etching the pustule (Figure 2). The ultrasound test of the tongue revealed an abscess with a diameter of 17x10x15 mm located on the right side of the tongue body. Neck and chest tomography excluded the involvement of other structures. The patient was then transferred to a specialist unit for definitive treatment. He was discharged a few days later, in good health and asymptomatic. The bacterial culture of the pus was negative. Discus...

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Section: Discussionsupporting

confidence: 55%