36 year old male with angioedema

Viharika Vupputuri 

Roll no- 144

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CASE PRESENTATION

 A 36 yr old male patient who is a watchman in a government hospital was admitted at 4AM on 12/01/2022 in the OPD with the chief complaints of 

1) Discomfort of the throat since 3-4 hrs

2) Swelling and pain in the throat

HISTORY OF PRESENTING ILLNESS

Patient was working asusual and then he developed swelling in the throat at 1AM in the morning of 12/01/2022.

Then he went to check himself in the mirror to examine and noticed swelling of throat.

Patient noticed that the swelling started at  uvula and progressed down till the whole throat is involved.

 

The swelling presented by the patient is sudden in onset and gradually progressive in nature since morning.

Pain is sudden in onset and gradually progressive in nature.

Patient was not able to turn his neck side to side.

PAST HISTORY

Patient had similar complaints in the past.

He was apparently asymptomatic 15 years back then he developed first episode of swelling in the throat associated with pain so he went to a local hospital and was referred to our hospital where tracheostomy was done.

He also had history of multiple swellings over the body which persists for atleast 3 days after using hydrocortisone.

It is not associated with redness, itching and irritation.

Swelling occurred in specific site would rapidly progress throughout the body.

This occurs atleast 2 times a month which is intermittent and random.

Swelling would occur on the face, trunk, upper and lower limb. Common site is face and limbs.

Then he developed 2nd episode in 2016 with complaints of swelling of base of tongue and uvula and tracheostomy was done.

He was not able to regularly work due to these symptoms.

Patient is not a known case of diabetes, hypertension, asthma, epilepsy, tuberculosis.

ALLERGIC HISTORY

Food allergy - Fish, Meat(mutton), leafy vegetable (gongura), brinjal.

Smell - perfume, garbage, sanitizer and smoke.

Pollutants.

PERSONAL HISTORY

Diet - Mixed 

Appetite - Normal

Bowel and bladder - Regular

Sleep - Inadequate

No Addictions

FAMILY HISTORY

Not significant.

TREATMENT HISTORY

Takes avil and hydrocortisone injections whenever swelling occurs.

SURGICAL HISTORY

Undergone tracheostomy 2 times.

GENERAL EXAMINATION

Patient is conscious, coherent and cooperative and is well oriented to time, place and person.

He is well nourished and moderately built.

Pallor - Absent

Icterus - Absent

Clubbing - Absent

Cyanosis - Absent

Lymphadenopathy - Absent

Edema - Absent

VITALS

Pulse rate - 120bpm

Respiratory rate - 16cpm

BP - 120/91 mmHg

Temperature - Afebrile

SYSTEMIC EXAMINATION 

EXAMINATION OF NOSE AND ORAL CAVITY

No Trismus.

Examination of oral cavity - lips, teeth,buccal mucosa and gums. 

Anterior 2/3rd of tongue, hard palate and floor of the mouth appears normal.

Examination of oral pharynx - congestion and oedema of anterior pillar, uvula and soft palate. Posterior pharyngeal wall appears congested.

Examination of nose - turbinates and mucosa appears normal 

RESPIRATORY SYSTEM

Examination of trachea - normal neck movements and tracheostomy scar seen.

Inspection 

Shape of the chest - Bilaterally symmetrical.

Position of trachea - deviated to left side.

Crowding of ribs - Absent.

Expansion of chest - equal on both sides.

No visible pulsations.

Palpation

No tenderness

No local rise of temperature.

Bilateral air entry.

Apex beat - Heard.

Percussion - resonant in all areas

Auscultation - normal vesicular breath sound

 

CVS

S1,S2 are heard.

No murmurs heard

ABDOMEN

Scaphoid shaped abdomen

No tenderness and palpable mass

No free fluid

Auscultation - bowel sounds heard

Liver - Not palpable

Spleen - Not palpable

CNS EXAMINATION

 

Conscious 

Normal speech

Cervical nerves - intact

Normal sensory and motor system

Neck stiffness - absent

Reflexes - normal

INVESTIGATIONS

PROVISIONAL DIAGNOSIS

Hereditary angioneurotic edema.

TREATMENT

1) Inj. hydrocortisone

2) Nebulization with adrenaline

3) Inj. avil i.v

4) Check BP, PR, RR, SPO2 - 2nd hrly.