ABSTRACT
A clinical vignette illustrates a typical presentation of a patient seeking help for acute angioedema. Despite the risks of SARS-CoV-2 (COVID-19) exposure, it is critical to evaluate patients with acute angioedema in person, because there is always the potential for angioedema to progress to the head, neck, or lungs, which can rapidly compromise the airways and require immediate intervention to avoid potential asphyxiation. There are three mediators of angioedema, histamine, leukotriene, or bradykinin, each requiring different management. This article provides clinicians essential information for differentiating between these types of angioedema, including an overview of the underlying pathogenies of angioedema, and the subjective and objective findings that are useful in differentiating between angioedema types. The article ends with the appropriate management for each type of acute angioedema, including the medications approved by the FDA for on-demand treatment of an HAE attack.
Subject(s)
Angioedema/diagnosis , COVID-19/epidemiology , Acute Disease , Angioedema/physiopathology , Angioedema/therapy , Anti-Allergic Agents/therapeutic use , Bradykinin/biosynthesis , Cyclooxygenase 2 Inhibitors/therapeutic use , Diagnosis, Differential , Histamine/biosynthesis , Histamine Antagonists/therapeutic use , Humans , Leukotrienes/biosynthesis , Omalizumab/therapeutic use , Otorhinolaryngologic Surgical Procedures/methods , Physical Examination , SARS-CoV-2Subject(s)
Angioedema , Angiotensin-Converting Enzyme Inhibitors , COVID-19 , Myocardial Infarction , Ramipril , Angioedema/chemically induced , Angioedema/physiopathology , Angioedema/therapy , Angioedema/virology , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/adverse effects , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Cardiovascular Agents/administration & dosage , Coronary Angiography/methods , Drug Substitution/methods , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/drug therapy , Myocardial Infarction/physiopathology , Patient Care Management , Platelet Aggregation Inhibitors/administration & dosage , Ramipril/administration & dosage , Ramipril/adverse effects , SARS-CoV-2 , Treatment OutcomeSubject(s)
Angioedema/etiology , Angioedema/physiopathology , Black or African American/statistics & numerical data , COVID-19/complications , COVID-19/physiopathology , SARS-CoV-2/pathogenicity , Aged , Angioedema/epidemiology , COVID-19/epidemiology , Female , Humans , Middle Aged , New York/epidemiology , PandemicsSubject(s)
Angioedema/virology , Coronavirus Infections/virology , Diabetes Mellitus, Type 2/virology , Hyperlipidemias/virology , Obesity/virology , Pneumonia, Viral/virology , Respiratory Insufficiency/virology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adult , Alanine/analogs & derivatives , Alanine/therapeutic use , Ampicillin/therapeutic use , Angioedema/immunology , Angioedema/physiopathology , Angioedema/therapy , Betacoronavirus/drug effects , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Diabetes Mellitus, Type 2/immunology , Diabetes Mellitus, Type 2/physiopathology , Diabetes Mellitus, Type 2/therapy , Female , Humans , Hydroxychloroquine/therapeutic use , Hyperlipidemias/immunology , Hyperlipidemias/physiopathology , Hyperlipidemias/therapy , Intubation, Intratracheal , Obesity/immunology , Obesity/physiopathology , Obesity/therapy , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/immunology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Treatment OutcomeABSTRACT
This is a case of a patient who presented with an urticarial rash 48 hours before developing symptoms of fever and a continuous cough. She subsequently developed angioedema of her lips and hands before testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Urticarial rashes occurring 48 hours before other symptoms of COVID-19 infection have been documented. This case demonstrates the importance of heightened awareness that not all urticarial rashes represent spontaneous urticaria and as a consequence, this may result in misdiagnosis and ultimately delayed diagnosis. This is the first reported case in the literature of urticaria with angioedema as a prodromal phenomenon of COVID-19.