SHM Converge Scientific Abstract ePoster Gallery-Lost in Translation: Diagnosing Acquired Angioedema Through Language Barriers

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This case describes a 68-year-old Spanish-speaking woman with a history of chronic lymphocytic leukemia in remission and autoimmune hemolytic anemia who presented with 4 months of left-sided neck pain, swelling, and hoarseness after receiving three antibiotic courses for presumed infection. Initial imaging showed pansinusitis and diffuse cervical lymphadenopathy without abscess, and direct laryngoscopy revealed significant supraglottic edema. Her symptoms worsened dramatically on hospital day 1 with acute dyspnea and tripoding, requiring IV dexamethasone. After steroids were stopped, she again decompensated on day 5, and repeat laryngoscopy showed worsening edema. Allergy specialists recommended treatment with Berinert for suspected C1-inhibitor deficiency, supported by a low C4 level, with improvement in respiratory status. She was discharged on prednisone, rituximab, and icatibant.<br /><br />The final diagnosis was suspected acquired angioedema due to C1-inhibitor deficiency, likely related to recurrence of her lymphoproliferative disease. The case highlights that acquired angioedema is rare but potentially fatal because airway edema can cause asphyxiation. It is especially associated with lymphoproliferative disorders.<br /><br />A major teaching point is the importance of effective interpreter use in healthcare. Patients with limited English proficiency are at higher risk for miscommunication and suboptimal care. Providers should use professional interpreters, speak directly to the patient in short sentences, ask one question at a time, and confirm understanding with teach-back, visual aids, and summaries. In this case, the patient’s subjective complaints of sore throat and throat pain were initially interpreted as infectious, delaying recognition of the airway edema.

Asset Subtitle

Rachel Cappello

Meta Tag

Author List Rachel Cappello, Tara K. Ward

Category Clinical Vignettes

Concept Acquired Angioedema

Concept C1 Esterase Inhibitor Deficiency

Concept Upper Airway Swelling

Concept Supraglottic Edema

Concept Angioedema

Distinguished Non-Finalist

Presenter Organization University of Colorado Hospital

Presenting Author Rachel Cappello

Track Adult

Keywords

acquired angioedema

C1-inhibitor deficiency

laryngeal edema

airway obstruction

lymphoproliferative disorder

chronic lymphocytic leukemia

supraglottic edema

low C4 level

rituximab

professional interpreter use

Acquired Angioedema

C1 Esterase Inhibitor Deficiency

Upper Airway Swelling

Supraglottic Edema

Angioedema