A 31-year-old, previously healthy man presents to urgent care with a complaint of abdominal pain and nausea accompanied by swelling of his hands and feet. The symptoms started 2 days ago and have gotten progressively worse. He reports no difficulty breathing. He is not taking any medications and denies any known allergies. Among the following choices, which is the most likely cause of this patient’s symptoms?
- Histamine-mediated angioedema
- Hereditary angioedema
- ACEI-induced angioedema
- Acute gastroenteritis
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Answer: B. Acute gastroenteritis is not typically accompanied by swelling of the extremities. The progressive onset of peripheral swelling accompanied by abdominal pain suggests a bradykinin-mediated angioedema, and hereditary angioedema is more likely in this case than ACEI-induced angioedema because this patient is not currently taking any medications and is unlikely to have taken ACEIs in the past.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
