A case of visceral angioedema diagnosed in the emergency department

Background

Angioedema is a non-pitting type of edema that involves subcutaneous tissue of the extremities, neck, face, lips, oral cavity, larynx, and gut that can be classified into hereditary or acquired forms. In the emergency department (ED), it is common for visceral angioedema to be undiagnosed due to similarity of presentation to other disorders.

Case Report

We present a case of a 65-year-old male with likely visceral angioedema due to underlying angiotensin-converting enzyme inhibitor use. He initially presented to an outside ED due to a nonspecific pruritic rash. He was discharged with a steroid prescription. The patient had another outside ED visit with the development of acute rapid facial swelling and shortness of breathing that progressed to respiratory distress. He was discharged again after a period of observation and treatment for anaphylaxis. Not long after, he developed gastrointestinal distress prompting his third visit to the ED, where he was diagnosed with visceral angioedema. Although the treatment of angioedema does not differ depending on the type, patients with more extensive presentation may require further monitoring.

Why should an emergency physician be aware of this?

Visceral angioedema is a rare complication and can easily be mistaken for other gastrointestinal pathology such as gastroenteritis. Emergency physicians need to understand the complexity of angioedema and the multiple organ systems that can be involved. Diligent review of patient medications and other historical factors that can cause angioedema and early treatment will lead to better outcomes for patients.