Persistent facial swelling

Abstract

We report on an 84-year-old female patient who presented to the emergency service of our clinic owing to marked swelling of the face (Figure 1). The complaints had first appeared five months earlier. Suspecting angioedema, systemic steroids (prednisolone up to a maximum of 250 mg/d) and antihistamines (cetirizine 40 mg/d) were repeatedly administered by the general practitioner. Under this therapy, however, there was only short-term improvement of the symptoms. At no time were there wheals, a globus sensation or dyspnea, nor were there gastrointestinal or cardiovascular symptoms. Known underlying diseases were diabetes mellitus type 2, hypothyroidism and arterial hypertension. Physical exami-nation revealed asymmetric indolent swelling of the face with diffuse erythema and telangiectasia. The cervical lymph nodes were bilaterally palpably enlarged.