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Endocrinology - Metabolic Disorders
A 50-year-old woman arrived at the emergency department with a one-day history of lip swelling. She reported no chest pain, difficulty breathing, or skin rashes. Her medical history included successfully treating breast cancer, epilepsy, asthma, and type 2 diabetes. She was taking several medications, including nifedipine, metformin, tamoxifen, levetiracetam, and sitagliptin, recently added to her treatment. She had experienced two previous episodes of angioedema, one triggered by an angiotensin receptor blocker (ARB) and the other by fosphenytoin. Upon arrival, her blood pressure was 146/73 mmHg, her heart rate was 69 beats/min, and her oxygen saturation was above 95% while breathing room air, with a respiratory rate of 18 breaths/min. Physical examination revealed swelling of both her upper and lower lips, as depicted in the figure below. There were no signs of breathing difficulty. Blood tests indicated normal levels for blood count, liver function, kidney function, and the C1 esterase inhibitor. The patient was treated with a five-day course of oral prednisone (40mg once daily) and diphenhydramine (25mg thrice daily), significantly improving her condition.
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