A Case of Recurrent Anaphylaxis.ppt

A Case of Recurrent Anaphylaxis Case presentationHistory of present illness 43 YO WF seen in the ER six times for anaphylaxis Initial episode after gardening and taking a walk Developed swelling of hands and feet, trouble breathing and swallowing Treated with oxygen, IV Benadryl and prednisone History of present illness She presented to the ER 3 more times over the next 4 weeks. Breathing progressively worse with each. All began with swelling of hands and feet, but no urticaria. No consistent pattern of exercise or food ingestion before-hand. Used Epipen at onset of fourth episode; unknown benefit Developed pyschosis secondary to steroid treatment History of present illness She was seen first by another allergist. Diagnosed as vascular leak syndrome and referred to a vascular surgeon Fifth episode associated with loss of consciousness. Admitted to pulmonary service History of present illness CXR abnormal and TB suspected; PPD negative and diagnosis R/O Sent home on daily loratadine Sixth episode described as trouble breathing without swelling. Seen in ER and sent home Presented for a second opinion Past Medical History Pneumonia Bronchitis, sinusitis No hx of asthma or rhinitis or hives Bipolar disorder Hypertension Herniated cervical discs Stevens-Johnson Syndrome (tegretol) Rash from penicillin, Demerol, codeine Family HX negative for anaphylaxis or angioedema ROS positive only for mild cough Physical exam – BP 140/80, P 72, PF 400, mild pedal edema Skin testing for inhalants negative RAST from other allergist negative for foods Laboratory Findings (from other allergist) WBC 9000, Hgb 11.8, Hct 35.7, MCV 105, MCH 34.6, Normal diff Metabolic panel WNL Urinalysis 3+ occult blood, 15-20 RBC/HPF C1 esterase inhibitor 30 mg/dl (28-40) C1q 13.5 (7.9-25) Anti-DNA (DS) Ab 25 U/ml (0-99) Hospital Records 6/28/03: Presented with swelling of throat and hands, shortness of breath, hoarseness, dizziness BP 143/84, P 95, R 28, O2 Sat 98% Exam showed swelling of