Angioedema with severe acute abdominal pain: Think of hereditary angioedema - 16/06/21
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Highlights |
• | Intestinal angioedema (IA) can mimic other causes of acute abdominal pain. |
• | IA can be histamine- or bradykinin-mediated, with distinct treatment requirements. |
• | Hereditary angioedema (HAE) is a rare form of bradykinin-mediated angioedema. |
• | Long delays in HAE diagnosis are common and have clinical and QoL ramifications. |
• | Accurate diagnosis of IA type is essential for instituting appropriate management. |
Summary |
Angioedema can be either mast cell-(histamine-)mediated or bradykinin-mediated. Treatment approaches for the two types are very different, making differential diagnosis critical. Severe acute abdominal pain caused by intestinal angioedema is commonly misdiagnosed, especially when associated with bradykinin-mediated angioedema. After describing a typical clinical scenario and diagnostic journey of a patient with recurrent, undiagnosed abdominal pain due to hereditary angioedema (HAE), a rare variant of bradykinin-mediated angioedema, we delve into the classification and differential diagnosis of the various types of angioedema and provide an overview of appropriate management with an emphasis on the bradykinin-mediated types. Bradykinin-induced angioedema may be inherited or acquired and is infrequent compared to mast cell-mediated angioedema. HAE is a rare disease characterized by recurrent attacks of non-urticarial, nonpruritic edema usually affecting the face, respiratory tract, extremities, gastrointestinal tract, and genitalia. Unlike mast cell-mediated angioedema, painful abdominal symptoms are prevalent in bradykinin-mediated angioedema and are sometimes the only manifestation of an attack, increasing the likelihood of initial misdiagnosis as appendicitis or other forms of acute abdomen. It is important for gastroenterologists to be vigilant for the possibility of angioedema pathology in patients presenting with undiagnosed, recurrent, abdominal symptoms to facilitate accurate diagnosis and effective treatment.
Le texte complet de cet article est disponible en PDF.Keywords : Hereditary angioedema, Intestinal angioedema, Acute abdominal pain, C1-INH deficiency, Bradykinin mediated
Plan
Vol 45 - N° 4
Article 101702- juillet 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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