Herein, we present a case presenting with recurrent episodes of abdominal pain and rash, which was diagnosed with idiopathic angioedema and was not responsive to first-line treatment. [ncbi.nlm.nih.gov]

Bradykinin mediated angioedema may sometimes present with gastrointestinal symptoms alone. [practicalgastro.com]

The patient’s allergist was called and notified of the patient’s presentation to the ED. [westjem.com]

[…] after presentation, another at 48 hours, and the last at 72 hours after presentation. [ajronline.org]

CASE REPORT A 63-year-old woman with no known medical history presented to the emergency room complaining of severe abdominal pain of acute onset. [journals.lww.com]

• Weight Loss

  She denied any weight loss. On presentation, she was afebrile, normotensive, and slightly tachycardic. Her abdomen was tender to palpation. Her pelvic exam was normal. [ncbi.nlm.nih.gov]

• Abdominal Pain

  Herein, we present a 34-year-old female who presented with recurrent episodes of abdominal pain. She underwent extensive workup for her abdominal pain and rash, and all was unrevealing except for high Immunoglobulin E (Ig E). [ncbi.nlm.nih.gov]

  Foster School of Medicine, El Paso, TX CASE REPORT A60 year old Hispanic female presented with generalized crampy abdominal pain of 24 hours duration. [practicalgastro.com]

  A rare cause of acute abdominal pain with ascites. Dtsch Med Wochenschr. 1998;123:1166–71. [PubMed] [westjem.com]

  Thus, it is an important diagnosis to consider in patients with acute onset of abdominal pain on ACEi therapy. [casereports.bmj.com]

  Acute gastroenteritis was very unlikely, given the lack of other symptoms beyond abdominal pain. [elsevier.es]

• Abdominal Tenderness

  Other pertinent findings included dry skin and mucous membranes, generalized abdominal tenderness with voluntary guarding but without rebound tenderness. Bowel sounds were hyperactive. [practicalgastro.com]

  Seven of 20 patients reported previous similar abdominal episodes. One had an episode of facial edema 6 months before admission. Physical findings included abdominal tenderness and normoactive bowel sounds in all patients. [ajronline.org]

• Dry Skin

  Other pertinent findings included dry skin and mucous membranes, generalized abdominal tenderness with voluntary guarding but without rebound tenderness. Bowel sounds were hyperactive. [practicalgastro.com]

She underwent extensive workup for her abdominal pain and rash, and all was unrevealing except for high Immunoglobulin E (Ig E). Multiple imaging came back negative for any pathology. [ncbi.nlm.nih.gov]

Such uncommon presentations are easily misdiagnosed, bearing serious consequences for the patient and the hospital system through unnecessary extensive workups. [practicalgastro.com]

Hepatitis B and C virus workup Rheumatoid factor Cryoglobulin levels Imaging studies Imaging studies Most angioedema patients do not need any imaging studies. [emedicine.medscape.com]

Workup is usually nondiagnostic including leukocytosis and nonspecific bowel wall thickening on CT scan. Therapy consists of withdrawal of the medication. This is a diagnosis of exclusion, and physicians must have a high index of suspicion. [hindawi.com]

In one study, it was shown that angioedema was more common in patients with CIU/CSU unresponsive to treatment as compared with patients responsive to treatment (59% vs. 29%) [11]. [ncbi.nlm.nih.gov]

Scoring took place at baseline and at 4 hours post-treatment. Efficacy assessments Treatment outcome score (TOS) Treatment outcome score (TOS) is a composite measure of symptom response to treatment. [bmcgastroenterol.biomedcentral.com]

Prompt detection and treatment of this rare disease can significantly improve patient outcome by minimizing morbidity from misdiagnosis or unnecessary operative interventions. [westjem.com]

The treatment guideline we have provided will also facilitate management decisions. [practicalgastro.com]

CT bowel changes long segment concentric thickening of the bowel submucosa jejunum more often affected mural stratification straightening of bowel loops no obstruction mild mesenteric edema ascites no lymphadenopathy Treatment and prognosis In cases of [radiopaedia.org]

CT bowel changes long segment concentric thickening of the bowel submucosa jejunum more often affected mural stratification straightening of bowel loops no obstruction mild mesenteric edema ascites no lymphadenopathy Treatment and prognosis In cases of [radiopaedia.org]

Prognosis The prognosis for patients with angioedema depends on the etiology and varies as follows: Angioedema with identifiable causes – If the trigger(s) can be identified and avoided, angioedema can be prevented Angioedema without identifiable causes [emedicine.medscape.com]

However, angioedema from both etiologies presents similarly and share a common mechanism. [westjem.com]

Interestingly, fresh frozen plasma has also shown efficacy in aborting acute attacks.6 In conclusion, physicians must remain mindful of this entity in patients presenting with acute abdominal pain, vomiting, or diarrhea of unknown etiology. [journals.lww.com]

[…] diarrhea secondary to extravasation of fluid into the intraluminal space.13 Discussion Abdominal pain is one of the most common conditions in clinical practice and yet a challenging complaint to accurately diagnose due to the vast number of possible etiologies [practicalgastro.com]

In addition, supportive care should be provided, regardless of the etiology. [emedicine.medscape.com]

Abdominal pain is a common presenting complaint in clinical practice, yet poses a diagnostic dilemma given the vast number of etiologies. [ncbi.nlm.nih.gov]

Epidemiology of angioedema without wheals in an allergy and immunology center. Medicina (B Aires) 2015; 75: 273-6. 3. Chan NJ, Soliman AM. Angiotensin converting enzyme inhibitor-related angioedema: onset, presentation, and management. [medicinabuenosaires.com]

Epidemiologic and clinical features of anaphylaxis in Korea. Ann Allergy Asthma Immunol. 2008 Jan. 100(1):31-6. [Medline]. Kalmár L, Hegedüs T, Farkas H, Nagy M, Tordai A. [emedicine.medscape.com]

Epidemiology The overall incidence of ACE-induced angioedema is reported to be about 0.1% to 0.2% and is 5 times more common in African Americans than among white patients [ 36 ]. [ncbi.nlm.nih.gov]

Pathophysiology Angioedema is a result of the fast onset of an increase in local vascular permeability in subcutaneous or submucosal tissue. [emedicine.medscape.com]

The pathophysiology behind it is a consequence of increased vascular permeability caused by the release of vasoactive mediators. [ncbi.nlm.nih.gov]

ACE inhibitor-induced angioedema of the intestine: case report, incidence, pathophysiology, diagnosis and management. Can J Gastroenterol, 15 (2001), pp. 827-832 [5] T. Campbell, B. Peckler, R.D. Hackstadt, A. Payor. [elsevier.es]

C1-INH is a serine-protease inhibitor that regulates the activation of the coagulation, kallikrein-kinin and complement systems, with the kallikrein-kinin system playing a central role in the pathophysiology of HAE-C1INH [7]. [bmcgastroenterol.biomedcentral.com]

Results of a double-blinded clinical trial in nine patients, reported in The New England Journal of Medicine in 1976, evaluated Danocrine’s efficacy in preventing acute hereditary angioedema attacks. [angioedemanews.com]

Although most cases typically resolve within 1–3 days, early recognition may prevent unnecessary imaging as well as possible exploratory surgery.4 DISCLOSURES Author contributions: A. Hassan and S. Weissman wrote and edited the manuscript. S. [journals.lww.com]

[…] antihistamines or occasionally steroid medication to reduce the swelling drug-induced angioedema will usually resolve if you change to a different medication – your doctor will advise you about this hereditary angioedema can't be cured, but medications can help prevent [nhs.uk]

Because the likelihood of side effects is greater, other drugs are usually reserved for when antihistamines fail to prevent angioedema, and are generally given under specialist supervision. [allergy.org.au]

Early diagnosis may prevent morbidity from unnecessary exploratory surgery. [westjem.com]