危及生命的 tPA 相关性血管性水肿:罕见病例报告与评论。

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Mohamad El Labban, Roba El Zibaoui, Alpha C Amadi, Tashfia Zareen, Syed Anjum Khan
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引用次数: 0

摘要

背景 血管性水肿的特征是真皮深层、皮下和粘膜下组织的局部自限性水肿。急性发作时常累及面部、嘴唇、舌头、四肢和生殖器皮肤,以及身体内部、呼吸道和胃肠道粘膜,可能危及生命。组胺和缓激肽是血管性水肿病理生理学中公认的血管活性介质。组织纤溶酶原激活剂(tPA)是一种纤维蛋白溶解剂,常用于治疗脑血管意外。血管性水肿是 tPA 的一种罕见不良反应,估计在心肌梗死或肺栓塞患者中的发生率为 0.02%,在中风患者中的发生率为 0.2% 至 5.1%。我们报告了一例独特的 tPA 相关性血管性水肿病例,并对其进行了 24 小时治疗。病例报告 一位 79 岁的男性患者因急性发作的右侧肢体无力、右侧面部下垂和言语困难来到急诊科就诊。经过初步评估,确定他可以接受 tPA 治疗。到达重症监护室后,他被发现右上唇和下唇肿胀。患者没有任何症状,也没有任何气道受损的迹象。治疗包括全身使用皮质类固醇和抗组胺药。通过连续图像进一步描述了血管性水肿的发展过程。经过治疗,血管性水肿完全消退。结论 血管性水肿是一种罕见但可能危及生命的 tPA 不良反应。虽然血管性水肿的病程一般较轻,且具有自限性,但它可能导致呼吸道受损,危及生命。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Life-Threatening tPA-Associated Angioedema: A Rare Case Report and Critical Review.

BACKGROUND Angioedema is characterized by localized self-limiting edema of the deep dermis, subcutaneous, and submucosal tissues. Acute episodes often involve the skin of the face, lips, tongue, limbs, and genitals, as well as internal areas of the body and respiratory and gastrointestinal mucosa, which could be life-threatening. Histamine and bradykinin are the most recognized vasoactive mediators in the pathophysiology of angioedema. Tissue plasminogen activator (tPA) is a fibrinolytic that is commonly used for the treatment of cerebrovascular accidents. Angioedema is a rare adverse effect of tPA, with an estimated incidence of 0.02% in patients with myocardial infarction or pulmonary embolism and 0.2% to 5.1% in patients with stroke. We report a unique case of tPA-associated angioedema with 24-h management. CASE REPORT A 79-year-old male patient presented to the Emergency Department with acute onset right-sided weakness, right-sided facial droop, and speech difficulties. Following the initial evaluation, it was determined that he was a candidate for receiving tPA therapy. On arrival at the Intensive Care Unit, he was noted to have right upper and then lower lip swelling. The patient was asymptomatic and did not show any signs concerning airway compromise. Treatment included systemic corticosteroids and antihistamines. The progression of the angioedema was further described with sequential images. The angioedema was completely resolved with treatment. CONCLUSIONS Angioedema is a rare but potentially life-threatening adverse effect of tPA. Although it generally has a mild self-limiting course, it can cause life-threatening airway compromise.

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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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