Malignancy masquerading as food hypersensitivity

Autor: M. Furrer, P. J. Späth, B. Wüthrich, M. Vogt, A. Fontana, E. P. Scheidegger
Rok vydání: 2001
Předmět:
Zdroj: Allergy. 56:349-358
ISSN: 1398-9995
0105-4538
DOI: 10.1034/j.1398-9995.2001.00074.x
Popis: A 54-YEAR-OLD woman was referred to the allergy unit of the department of dermatology at University Hospital Zurich for a diagnostic work-up after she had emergency treatment for an episode of angioedema of the tongue and throat. Angioedematous symptoms occurred 30 min after she ate a spaghetti dinner with clam and tomato sauce. Otherwise, the personal history was noncontributory, except for the mild pancytopenia reported in the referral letter. In particular, no previous food allergies/intolerance reactions were reported. Angioedema and the patient's complaint of persistent gastrointestinal pain prompted the assessment of complement C4 and the regulatory protein C1 inhibitor (C1INH). Both proteins were undetectable (C4 ,0.01 g/l, normal range 0.1±0.4; C1-INH concentration ,0.03 g/l, normal range 0.2±0.36; C1-INH function ,18%, normal range 70±135%). A preliminary diagnosis of hereditary (HAE) or acquired angioedema (AAE) was made, and treatment with the attenuated androgen danazol (400 mg daily for 2 weeks; then 200 mg per day for a total duration of 3 weeks) was initiated. Ten days after initiation of danazol therapy, a rise in the international normalized ratio (INR) for coagulation was noted. A subsequent coagulation work-up revealed the presence of antiphospholipid antibodies (anticardiolipin-IgM 520 IU/l, normal ,15 IU/l). Serology for antinuclear and antinative DNA antibodies was unremarkable, excluding the diagnosis of systemic lupus erythematosus (SLE). The initial diagnosis was revised in favor of acquired C1-INH de®ciency in association with antiphospholipid antibody syndrome. AAE was con®rmed in two individual samples collected 1 day apart by low C1q and C1r values (C1q: 0.014 g/l, normal range 0.046±0.116 g/l; C1r 37%, normal range 75±125%, respectively). Finally, a bone-marrow biopsy specimen allowed us to diagnose AAE in conjunction with B-cell non-Hodgkin's lymphoma (NHL, IgG k). This particular case seems to be very instructive for various reasons
Databáze: OpenAIRE
Externí odkaz: