SHM Converge Scientific Abstract ePoster Gallery-A Rare Cause of Severe Angioedema in a 70-Year-Old Man

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This case describes a 70-year-old man with hypertension who presented with sudden severe facial swelling after several hours of generalized abdominal pain. Because of concern for airway compromise, he underwent emergency fiberoptic nasal intubation, received empiric treatment with steroids, diphenhydramine, famotidine, and fresh frozen plasma, and was admitted to the ICU. His swelling improved gradually and completely resolved by hospital day 3, allowing extubation.<br /><br />Laboratory work-up showed markedly low C1 esterase inhibitor function, undetectable C4, and low C1q, supporting a diagnosis of acquired angioedema due to C1-INH deficiency. The late age of onset and lack of family history made hereditary angioedema less likely. The patient also reported an 8-month history of unexplained abdominal pain and hypotensive episodes, suggesting prior unrecognized angioedema attacks.<br /><br />He was discharged with outpatient allergy follow-up and prescribed berotralstat for prevention and icatibant for emergency use. Because acquired angioedema can be associated with lymphoproliferative disease, he was referred to hematology and, three months later, diagnosed with diffuse large B-cell lymphoma. PET imaging showed widespread lymphadenopathy and splenomegaly.<br /><br />The report emphasizes that acquired angioedema is a rare but life-threatening bradykinin-mediated disorder often mistaken for allergic angioedema. Key clues include late onset, abdominal symptoms, low C1-INH function, low C4, and low C1q. Early recognition is important not only for acute airway management but also because it may reveal an underlying malignancy or autoimmune disorder.

Asset Subtitle

Lindsey N. Vu

Meta Tag

Author List Lei Lynn, Lindsey N. Vu, Scarlett Bergam

Category Clinical Vignettes

Concept Acquired Angioedema

Concept C1 Esterase Inhibitor Deficiency

Concept Angioedema

Concept C1 Esterase Inhibitor Function

Concept Airway Protection

Distinguished Non-Finalist

Presenter Organization George Washington University Hospital

Presenting Author Lindsey N. Vu

Track Adult

Keywords

acquired angioedema

C1 esterase inhibitor deficiency

bradykinin-mediated angioedema

airway compromise

fiberoptic nasal intubation

low C4

low C1q

abdominal pain

diffuse large B-cell lymphoma

berotralstat

Acquired Angioedema

C1 Esterase Inhibitor Deficiency

Angioedema

C1 Esterase Inhibitor Function

Airway Protection