RESUMEN
Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Accidente Cerebrovascular Isquémico/complicaciones , Angioedema/inducido químicamente , Angioedema/terapia , Plasma , Histamina , Manejo de la Vía AéreaRESUMEN
The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.
Asunto(s)
Angioedema , Accidente Cerebrovascular Isquémico , Femenino , Humanos , Anciano , Accidente Cerebrovascular Isquémico/complicaciones , Angioedema/inducido químicamente , Angioedema/terapia , Manejo de la Vía Aérea , Histamina , PlasmaRESUMEN
BACKGROUND: Acquired angioedema due to C1 inhibitor deficiency (AAE-C1-INH) is a very rare disease. In clinical practice, it may be difficult to differentiate AAE-C1-INH from hereditary angioedema due to C1-INH deficiency (HAE-C1-INH). In both conditions, patients are at an increased risk of death from asphyxiation due to upper airway obstruction. The association of AAE-C1-INH with lymphoproliferative and autoimmune diseases, and with presence of anti-C1-INH antibodies has been well documented, and treatment of the underlying condition may result in complete remission of angioedema. OBJECTIVES: To discuss the clinical evaluation, diagnosis, and treatment outcomes of AAE-C1-INH in the context of the care of 2 patients with recurrent isolated angioedema. METHODS: Two patients were followed up prospectively at our clinic. Measurements of C3, C4, C1-INH, and C1q levels were carried out by nephelometry, and the functional activity of C1-INH was determined by a chromogenic assay. Hematological investigation included morphological and immunophenotyping analysis of peripheral blood, bone marrow, and spleen histopathology. Sequencing of the 8 exons and adjacent intronic regions of the SERPING1 gene was performed using the Sanger method. RESULTS: Two patients were diagnosed with AAE-C1-INH associated with splenic marginal zone lymphoma during follow-up. CONCLUSIONS: Close follow-up, including detailed clinical history, physical examination, and laboratory tests, of our patients with AAE-C1-INH was essential for the early diagnosis and successful treatment of the lymphoproliferative disease, leading to the resolution of the angioedema attacks.
Asunto(s)
Angioedema/diagnóstico , Angioedemas Hereditarios/diagnóstico , Linfoma de Células B de la Zona Marginal/diagnóstico , Bazo/patología , Neoplasias del Bazo/diagnóstico , Angioedema/terapia , Angioedemas Hereditarios/terapia , Detección Precoz del Cáncer , Servicios Médicos de Urgencia , Epinefrina/uso terapéutico , Femenino , Humanos , Linfoma de Células B de la Zona Marginal/terapia , Persona de Mediana Edad , Nefelometría y Turbidimetría , Neoplasias del Bazo/terapiaRESUMEN
Abstract Background and objectives: Late pressure angioedema is a rare form of angioedema in which light pressure stimulus can lead to edema after 1-12 h. This uncommon and unreported entity is especially important in patients who undergo general anesthesia, for whom the usual harmless supine position, intravenous catheter insertion, standard monitoring, airway management and ventilation can lead to life threatening consequences as the trigger is a physical stimulus. Case report: In this report, we describe a successful perioperative anesthetic management of a 30 year old patient, proposed for intra-ocular lens insertion, with a severe form of the disease with peri-oral, tongue and limb edema presentation. Conclusion: Due to lack of quality evidence, our conduct was based on the pathophysiology mechanisms of the syndrome, histamine and pro-inflammatory cytokines release, with special focus on a careful peri-operative assessment and prophylaxis, minimization of all the possible pressure stimulus, especially in the airway structures, and a strict post-operative monitoring.
Resumo Justificativa e objetivos: Angioedema de pressão tardio é uma forma rara de angioedema na qual um leve estímulo de compressão pode levar a edema após 1-12 horas. Essa entidade incomum e pouco relatada é especialmente importante em pacientes submetidos à anestesia geral, nos quais a habitual posição supina inofensiva, inserção intravenosa do cateter, monitoração padrão, manejo das vias aéreas e ventilação podem levar a consequências fatais, pois o gatilho é um estímulo físico. Relato de caso: Neste relato, descrevemos o manejo anestésico perioperatório bem-sucedido de um paciente de 30 anos idade, agendado para inserção de lente intraocular, com uma forma grave da doença, apresentava edema perioral, língual e nos membros. Conclusão: Devido à falta de evidências de qualidade, nossa conduta teve como base os mecanismos fisiopatológicos da síndrome, a liberação de histamina e citocinas pró-inflamatórias, com foco especial em uma avaliação cuidadosa no perioperatório e profilaxia, diminuição de todos os estímulos compressíveis possíveis, especialmente nas estruturas das vias aéreas, e um acompanhamento rigoroso no pós-operatório.
Asunto(s)
Humanos , Masculino , Anestesia/métodos , Angioedema/terapia , Factores de TiempoRESUMEN
BACKGROUND AND OBJECTIVES: Late pressure angioedema is a rare form of angioedema in which light pressure stimulus can lead to edema after 1-12h. This uncommon and unreported entity is especially important in patients who undergo general anesthesia, for whom the usual harmless supine position, intravenous catheter insertion, standard monitoring, airway management and ventilation can lead to life threatening consequences as the trigger is a physical stimulus. CASE REPORT: In this report, we describe a successful perioperative anesthetic management of a 30 year old patient, proposed for intra-ocular lens insertion, with a severe form of the disease with peri-oral, tongue and limb edema presentation. CONCLUSION: Due to lack of quality evidence, our conduct was based on the pathophysiology mechanisms of the syndrome, histamine and pro-inflammatory cytokines release, with special focus on a careful peri-operative assessment and prophylaxis, minimization of all the possible pressure stimulus, especially in the airway structures, and a strict post-operative monitoring.
Asunto(s)
Anestesia , Angioedema , Anestesia/métodos , Angioedema/terapia , Humanos , Masculino , Factores de TiempoRESUMEN
Angioedema is defined as edema of the skin or mucosa, including the respiratory and the gastrointestinal mucosa, which is self-limiting, and in most cases is completely resolved in less than 72 hours. It occurs due to increased permeability of the mucosal and submucosal capillaries and postcapillary venules, with resulting plasma extravasation. There are different types of angioedema: histaminergic (which may be mediated by immunoglobulin E), hereditary, from acquired C1 inhibitor deficiency, from angiotensin converting enzyme inhibitor, bradykinin-mediated, and non-histaminergic idiopathic angioedema. Treatment depends on the cause of angioedema, age, and the frequency and severity of manifestations. The main measures are avoiding external triggers or causes, giving antihistamines, steroids, or adrenaline for histaminergic angioedema; replacing the deficient protein or blocking the action of bradykinin in C1 inhibitor deficiency and angioedema from angiotensin converting enzyme inhibitor.
El angioedema se define como el edema de piel o mucosas, incluidas las de los tractos respiratorio y gastrointestinal, de carácter autolimitado, que en la mayoría de los casos se resuelve en forma completa en menos de 72 horas. Ocurre por aumento de la permeabilidad de los capilares mucosos, submucosos y vénulas poscapilares, con la consiguiente extravasación del plasma. Existen diferentes tipos de angioedema: el histaminérgico (que puede ser mediado o no por inmunoglobulina E), el hereditario, por déficit de C1 inhibidor adquirido, por inhibidores de la enzima convertidora de la angiotensina, mediados por bradiquininas y el angioedema no histaminérgico idiopático. El tratamiento depende de la causa del angioedema, la edad, frecuencia y gravedad de sus manifestaciones. Las principales medidas son evitar los desencadenantes o disparadores externos, la administración de antihistamínicos, esteroides o adrenalina en el angioedema histaminérgico; el reemplazo de la proteína deficiente o el bloqueo de la acción de la bradiquinina en el déficit de C1 inhibidor y en el angioedema por inhibidores de la enzima convertidora de la angiotensina.
Asunto(s)
Angioedema , Factores de Edad , Angioedema/clasificación , Angioedema/etiología , Angioedema/terapia , Angioedemas Hereditarios/etiología , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Bradiquinina/antagonistas & inhibidores , Permeabilidad Capilar , Humanos , VénulasRESUMEN
É relatado um caso de paciente com quadro de urticária crônica e angioedema com mais de 18 anos de evolução. Mal controle de sintomas com tratamento convencional e visitas cada vez mais frequentes ao pronto socorro deterioravam sua qualidade de vida e traziam insegurança devido ao potencial de gravidade do quadro. Em sua primeira consulta homeopática foi verificado alto grau de semelhança sintomática com a patogenesia de Apis mellifica, o qual foi introduzido e modificou a história de vida da paciente em questão, com excelente controle do quadro clínico. Foi realizada revisão da literatura sobre urticária e o policresto Apis mellifica. Este relato tem como objetivos chamar atenção para a existência e importância de recursos terapêuticos não convencionais, como é o caso da homeopatia, e também compartilhar com os colegas homeopatas a condução do caso, desde o diagnóstico e escolha do medicamento, ao seguimento da paciente.
We report the case of a patient with chronic urticaria and angioedema for more than 18 years. The symptoms were poorly checked with conventional treatment and increasingly frequent visits to the emergency department seriously affected the patients quality of life, in addition to making her feel insecure about the severity of her condition. During the first homeopathic consultation we detected a high degree of similarity with the pathogenetic symptoms of Apis mellifica. The remedy was prescribed and changed the patients life history, achieving excellent control of her clinical condition. A literature review was performed on urticaria and polycrest medicine Apis mellifica. The aim of this case report is to call the attention to the availability and relevance of non-conventional therapeutic resources, such as homeopathy, and to share with colleagues aspects of the case management from diagnosis and medicine selection to follow up.
Asunto(s)
Femenino , Humanos , Adulto Joven , Angioedema/terapia , Abejas/uso terapéutico , Homeopatía , Urticaria/terapiaRESUMEN
É relatado um caso de paciente com quadro de urticária crônica e angioedema com mais de 18 anos de evolução. Mal controle de sintomas com tratamento alopático e visitas frequentes ao pronto socorro deterioravam sua qualidade de vida e traziam insegurança devido ao potencial de gravidade do quadro. Em sua primeira consulta homeopática foi verificado alto grau de semelhança sintomática com a patogenesia de Apis mellifica, o qual foi introduzido e modificou a história de vida da paciente em questão, com excelente controle do quadro clínico. Realizada revisão da literatura sobre urticária e o policresto Apis mellifica, que vem sendo estudado in vitro na busca por evidências que possam explicar os efeitos da Homeopatia. (AU)
Reported case of a pacient with chronic urticaria and angioedema of more than 18 years of evolution. Poor control of symptoms with allopathic treatment and frequent visits to the emergency room deteriorated her quality of life and brought insecurity due to the potencial severity of the condition. In her first homeopathic appointment was verified high degree of symptomatic similarity to the pathogenesis of Apis mellifica, which was introduced and modified the patients life history, with excellent control of the condition. Performed literature review on urticaria and the policresto Apis mellifica that has been studied in vitro in search for evidence that might explain the effects of Homeopathy. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Homeopatía , Abejas/uso terapéutico , Urticaria/terapia , Angioedema/terapiaRESUMEN
É relatado um caso de paciente com quadro de urticária crônica e angioedema com mais de 18 anos de evolução. Mal controle de sintomas com tratamento convencional e visitas cada vez mais frequentes ao pronto socorro deterioravam sua qualidade de vida e traziam insegurança devido ao potencial de gravidade do quadro. Em sua primeira consulta homeopática foi verificado alto grau de semelhança sintomática com a patogenesia de Apis mellifica, o qual foi introduzido e modificou a história de vida da paciente em questão, com excelente controle do quadro clínico. Foi realizada revisão da literatura sobre urticária e o policresto Apis mellifica.Este relato tem como objetivos chamar atenção para a existência e importância de recursos terapêuticos não convencionais, como é o caso da homeopatia, e também compartilhar com os colegas homeopatas a condução do caso, desde o diagnóstico e escolha do medicamento, ao seguimento da paciente. (AU)
We report the case of a patient with chronic urticaria and angioedema for more than 18 years. The symptoms were poorly checked with conventional treatment and increasingly frequentvisitsto the emergency department seriously affectedthe patients quality of life, in addition to makingher feel insecure about the severity of her condition. During the first homeopathic consultation we detected a high degree of similarity with the pathogenetic symptoms of Apis mellifica. The remedy was prescribed and changed the patients life history, achieving excellent control of her clinical condition. A literature review was performed on urticaria and polycrest medicine Apis mellifica. The aim of this case report is to call the attention to the availability and relevance of non-conventional therapeutic resources, such as homeopathy, and to share with colleagues aspects of the case management from diagnosis and medicine selection to follow up. (AU)
Asunto(s)
Humanos , Femenino , Adulto Joven , Homeopatía , Abejas/uso terapéutico , Urticaria/terapia , Angioedema/terapiaAsunto(s)
Angioedema/diagnóstico , Angioedema/terapia , Urticaria/diagnóstico , Urticaria/terapia , HumanosRESUMEN
Angioneurotic oedema is an acute swelling involving the submucosal or subcutaneous tissues; it is most often located in the oral and maxillofacial region, which can result in upper airway obstruction. Its aetiology is frequently associated with immunoglobulin-mediated hypersensitivity reactions that elicit a heightened inflammatory response. The objective of this study was to report the case of a patient who developed an episode of angioneurotic oedema following combined orthognathic surgery. Pharmacological and nonpharmacological interventions used in the treatment of this important clinical condition are described and discussed.
Asunto(s)
Angioedema/terapia , Procedimientos Quirúrgicos Ortognáticos , Complicaciones Posoperatorias , Angioedema/etiología , Antiinflamatorios/uso terapéutico , Epinefrina/uso terapéutico , Cara , Asimetría Facial/cirugía , Femenino , Estudios de Seguimiento , Humanos , Hidrocortisona/uso terapéutico , Enfermedades de los Labios/etiología , Enfermedades de los Labios/terapia , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Osteotomía/efectos adversos , Osteotomía/métodos , Piroxicam/análogos & derivados , Piroxicam/uso terapéutico , Vasoconstrictores/uso terapéutico , Adulto JovenRESUMEN
Se presenta el caso de una niña con diagnóstico de urticaria autoinmunitaria y su evolución terapéutica con omalizumab. Caso clínico. Paciente de sexo femenino de 12 años de edad con un cuadro de urticaria crónica grave y angioedema de 14 meses de evolución, escasa respuesta a dosis máximas de 3 antihistamínicos combinados, antileucotrienos y corticoides, y gran afectación de su calidad de vida. Se realizó una prueba de suero autólogo, que fue positiva hasta la dilución 1:100, llegándose al diagnóstico de urticaria crónica autoinmunitaria. La falta de respuesta al tratamiento lleva a indicar terapia con omalizumab, con una reducción notable de los síntomas hacia la tercera dosis y ausencia de ellos tras 12 meses de tratamiento. Conclusión. El omalizumab podría ser una opción terapéutica para pacientes con urticaria autoinmunitaria que no responden a otros tratamientos.(AU)
We report the case of a child with diagnosis of chronic urticaria/angioedema and its evolution upon omalizumab treatment. Case report. Our patient is a 12-years-old female who suffered for 14 months severe chronic urticaria/angioedema. She had a poor response to the highest doses of combined therapy with 3 antihistamines, steroids and anti-leukotrienes and great impairmentof her quality of life. An autologous serum skin test was positive until 1:100 dilutions, leading to the diagnosis of chronic autoimmune urticaria. Due to the lack of response to treatment, therapy with omalizumab was administered. A notable reduction in symptoms toward the third dose was observed. After 12 months of this treatment, the patient is asymptomatic and has a negative autologousserum test. Conclusion. Omalizumab could be a therapeutic option for patients with autoimmune urticaria unresponsive to other treatments.(AU)
Asunto(s)
Humanos , Niño , Femenino , Angioedema/etiología , Angioedema/terapia , Angioedema/fisiopatología , Urticaria/fisiopatología , Urticaria/terapia , Enfermedades Autoinmunes , AntialérgicosRESUMEN
Se presenta el caso de una niña con diagnóstico de urticaria autoinmunitaria y su evolución terapéutica con omalizumab. Caso clínico. Paciente de sexo femenino de 12 años de edad con un cuadro de urticaria crónica grave y angioedema de 14 meses de evolución, escasa respuesta a dosis máximas de 3 antihistamínicos combinados, antileucotrienos y corticoides, y gran afectación de su calidad de vida. Se realizó una prueba de suero autólogo, que fue positiva hasta la dilución 1:100, llegándose al diagnóstico de urticaria crónica autoinmunitaria. La falta de respuesta al tratamiento lleva a indicar terapia con omalizumab, con una reducción notable de los síntomas hacia la tercera dosis y ausencia de ellos tras 12 meses de tratamiento. Conclusión. El omalizumab podría ser una opción terapéutica para pacientes con urticaria autoinmunitaria que no responden a otros tratamientos.
We report the case of a child with diagnosis of chronic urticaria/angioedema and its evolution upon omalizumab treatment. Case report. Our patient is a 12-years-old female who suffered for 14 months severe chronic urticaria/angioedema. She had a poor response to the highest doses of combined therapy with 3 antihistamines, steroids and anti-leukotrienes and great impairmentof her quality of life. An autologous serum skin test was positive until 1:100 dilutions, leading to the diagnosis of chronic autoimmune urticaria. Due to the lack of response to treatment, therapy with omalizumab was administered. A notable reduction in symptoms toward the third dose was observed. After 12 months of this treatment, the patient is asymptomatic and has a negative autologousserum test. Conclusion. Omalizumab could be a therapeutic option for patients with autoimmune urticaria unresponsive to other treatments.
Asunto(s)
Humanos , Niño , Femenino , Enfermedades Autoinmunes , Antialérgicos , Angioedema/etiología , Angioedema/fisiopatología , Angioedema/terapia , Urticaria/fisiopatología , Urticaria/terapiaRESUMEN
Adverse reactions to nonsteroidal antinflammatory drugs are the second cause of reactions to drugs after beta-lactams. Prevalence of these reactions among general population is between 0.1-0.3%, and prevalence of nonsteroidal antinflammatory drug-induced anaphylaxis is 0.01%. Acetylsalicylic acid or nonsteroidal antinflammatory drug sensitivity can be manifested as acute urticaria, angioedema, acute asthma, acetylsalicylic acid exacerbated respiratory disease and anaphylaxis. An updated review based on three cases of patientes with acetylsalicylic acid or nonsteroidal antinflammatory drug intolerance is presented in which, because of their concomitant diseases, permanent treatment with acetylsalicylic acid was required. After undergoing a fast acetylsalicylic acid desentization protocol in an intensive care unit, these patients were able to receive daily acetylsalicylic acid doses without any adverse effects.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/efectos adversos , Aspirina/uso terapéutico , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/terapia , Adulto , Anafilaxia/inducido químicamente , Angioedema/inducido químicamente , Angioedema/terapia , Antiasmáticos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Aspirina/administración & dosificación , Asma/complicaciones , Asma/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/terapia , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/inmunología , Hipersensibilidad a las Drogas/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Pólipos Nasales/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Rinitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Trombofilia/tratamiento farmacológico , Urticaria/inducido químicamente , Urticaria/terapiaRESUMEN
Hereditary angioedema is a congenital disorder with recurrent attacks of localized swelling of submucosal and subcutaneous tissue, or both caused by a deficiency of the plasma protein C1 inhibitor. It is caused by heterozygous defects in the C1 inhibitor gene located on chromosome 11q, and it has an autosomal dominant inheritance pattern. This disease afflicts 1 in 10,000 to 1 in 150,000 persons. Hereditary angioedema has been reported in all races, and no sex predominance has been found. Skin and visceral organs may be involved by the typically massive local edema. The most commonly involved viscera are the respiratory and gastrointestinal systems, and it can affect the upper airways resulting in severe life-threatening symptoms, including the risk of asphyxiation. There are three types of hereditary angioedema, which difference lies in the inheritance pattern and in the C1 esterase inhibitor and C4 concentrations. The treatment is complicated and it should be treated with intravenous purified C1 inhibitor concentrate; corticosteroids, antihistamines and epinephrine can be useful adjuncts but they are not effective. We report a patient with hereditary angioedema type 1 and make a review of the medical literature.
Asunto(s)
Angioedema/genética , Proteínas Inactivadoras del Complemento 1/deficiencia , Serpinas/deficiencia , Adulto , Angioedema/clasificación , Angioedema/tratamiento farmacológico , Angioedema/epidemiología , Angioedema/fisiopatología , Angioedema/terapia , Bradiquinina/fisiología , Terapia Combinada , Proteínas Inactivadoras del Complemento 1/genética , Proteínas Inactivadoras del Complemento 1/uso terapéutico , Proteína Inhibidora del Complemento C1 , Complemento C4/deficiencia , Danazol/uso terapéutico , Quimioterapia Combinada , Femenino , Genes Dominantes , Humanos , Incidencia , Serpinas/genética , Serpinas/uso terapéuticoRESUMEN
Angioedema is a rare reaction to streptokinase, acute and potentially fatal, which should be quickly diagnosed and treated to guarantee the best prognosis for the patient. We describe here the case of a 65-year-old man, who displayed an anaphylactic reaction after the beginning of thrombolysis with streptokinase, which was quickly treated, and remained hospitalized for one week in the Intensive Care Unit.
Asunto(s)
Angioedema/inducido químicamente , Fibrinolíticos/efectos adversos , Estreptoquinasa/efectos adversos , Anciano , Angioedema/diagnóstico , Angioedema/terapia , Electrocardiografía , Humanos , MasculinoRESUMEN
The skin is the largest body's organ, with a well defined functional lymphoid tissue. This organ can be the target of several hypersensitivity-mediated diseases, that are both, genetically determined and influenced by environmental factors. In this paper the main clinical features and the current treatment modalities for the most frequent allergic cutaneous diseases are reviewed.