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 Gain

  Additional information Due to its interference with sex hormones, the most common side effects of Danocrine are acne, weight gain, deepening of the voice, male-like hair growth, and menstrual irregularities. [angioedemanews.com]

• Virilization

  Side effects ranging from weight gain and virilization (or male-like characteristics in women), to menstrual irregularities and headache or depression were reported by in 93 of the 118 patients, and led 30 to stop the treatment. [angioedemanews.com]

• Deepening of Voice

  Other reversible side effects in women include deepening of voice, menstrual irregularities, acne, and hirsutism. [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]

  As her facial angioedema resolved, so did her abdominal pain. The abdominal pain did not return after discontinuing the ACE inhibitor, leading to this diagnosis of exclusion. At 6-month followup, the patient remained free of abdominal pain. [hindawi.com]

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

  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]

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

• Vomiting

  She mentioned that it occurred after drinking her daily green smoothie, after which she immediately developed severe abdominal cramping, nausea, vomiting, and watery diarrhea. [journals.lww.com]

  Pain was associated with nausea, intractable vomiting, dyspnoea and dizziness. Ten-point review of systems was negative except for the above reported symptoms. Vitals on admission were stable. [casereports.bmj.com]

  Patients often present with non-specific findings of abdominal pain, nausea, and vomiting. [radiopaedia.org]

  We report a case of a 34-year-old woman who presented with abdominal cramping, vomiting and diarrhea due to an acute exacerbation of HAE. [westjem.com]

  Visceral edema in the digestive system can manifest as nausea, vomiting, abdominal pain, diarrhea, and constipation, depending on the location that is involved. [ncbi.nlm.nih.gov]

• Diarrhea

  She mentioned that it occurred after drinking her daily green smoothie, after which she immediately developed severe abdominal cramping, nausea, vomiting, and watery diarrhea. [journals.lww.com]

  We report a case of a 34-year-old woman who presented with abdominal cramping, vomiting and diarrhea due to an acute exacerbation of HAE. [westjem.com]

  Pain was acute in onset and associated with nausea, nonbilious emesis, and several bouts of watery, nonbloody diarrhea. She denied fever, chills, dysuria or sick contacts. [practicalgastro.com]

  She has had a similar episode in the past; the most recent being three months prior, which was also associated with an itchy rash and abdominal pain and diarrhea. [ncbi.nlm.nih.gov]

  Common symptoms include abdominal pain, vomiting, diarrhea, and ascites [3–5]. [hindawi.com]

• Angioedema

  This is even more poignant in the cases of urticaria-associated angioedema. [ncbi.nlm.nih.gov]

  The clinical findings and treatment of intestinal angioedema are summarized in Tables 1 and and 2. Table 1. Clinical Features of intestinal Hereditary Angioedema and ACE-inhibitor associated angioedema. Table 2. [westjem.com]

  INTRODUCTION There are two main categories of angioedema: the mast-cell mediated and the bradykinin mediated angioedema.1 Bradykinin mediated angioedema, unlike the mast-cell mediated angioedema is usually without symptoms of pruritus and urticaria and [practicalgastro.com]

  CT of angioedema of the small bowel. AJR Am J Roetgenol. 2001;176:649–52. Cited Here 4. Palmquist S, Mathews B. Isolated intestinal type angioedema due to ACE‐inhibitor therapy. Clin Case Rep. 2017;5(5):707–10. Cited Here 5. [journals.lww.com]

• Pruritus

  INTRODUCTION There are two main categories of angioedema: the mast-cell mediated and the bradykinin mediated angioedema.1 Bradykinin mediated angioedema, unlike the mast-cell mediated angioedema is usually without symptoms of pruritus and urticaria and [practicalgastro.com]

  She was previously asymptomatic and, at admission, did not have any other symptoms, including nausea, vomiting, diarrhea or any other gastrointestinal symptom, breathing difficulty, cough, rash or pruritus. [elsevier.es]

  In addition, pruritus is the most prominent complaint in urticaria, but it is less troublesome or absent in angioedema. Furthermore, pain or tenderness is uncommon in urticaria but frequent or even severe in angioedema. [emedicine.medscape.com]

• Suggestibility

  Findings, the researchers wrote, “suggest that treatment with the lowest effective doses of danazol does not influence growth.” [angioedemanews.com]

  Physical examination suggested peritoneal irritation on the lower quadrants of the abdomen and right flank. Laboratory tests were relevant for mild leukocytosis. [elsevier.es]

  Research suggests that estrogen may play a role in some forms of hereditary angioedema [13]. [ajronline.org]

  Some studies suggest that patients with a deficiency of aminopeptidase-P, another enzyme that catabolizes bradykinin, are at an increased risk of developing of angioedema from ACEI [13, 17, 20]. [hindawi.com]

  The CT revealed dependant ascites in the abdominal and pelvic peritoneal cavities and discontinuous mural thickening in the proximal and middle small bowel suggestive of intestinal angioedema (Figures 1 and and 2). Figure 1. [westjem.com]

• Dark Urine

  Liver problems can be recognized by dark urine, stomach pain, yellowing of the skin or the eyes, fatigue, or bruising. *** Angioedema News is strictly a news and information website about the disease. [angioedemanews.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]

• Dyslipidemia

  Medical history was significant for multiple admissions in the past for similar episodes as well as hypertension, diabetes mellitus type 2, chronic deep venous thrombosis and dyslipidemia. [practicalgastro.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]

It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. [angioedemanews.com]

The treatments recommended depend on the type of angioedema you have. [nhs.uk]

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]

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]

A review of the literature and pathophysiology,” Annals of Internal Medicine, vol. 117, no. 3, pp. 234–242, 1992. View at: Google Scholar R. A. Sabroe and A. [hindawi.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]

[…] 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]

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]

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]

Making the diagnosis can prevent patients from exposure to costly and invasive procedures. 2. [hindawi.com]