Urticaria, angioedema, and an elevated eosinophil count in an adolescent
| Autor: | Jack L. Armstrong, Andrea B. Lantz, Carol F. Meyer, Rita Jerath |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Allergy Abdominal pain medicine.medical_specialty Urticaria Anti-nuclear antibody Stridor Immunology Immunoglobulin E Serology Diagnosis Differential Leukocyte Count Eosinophilia Hypereosinophilic Syndrome medicine Humans Immunology and Allergy Angioedema Child biology business.industry Angioneurotic oedema medicine.disease Rash Dermatology biology.protein medicine.symptom business |
| Zdroj: | Annals of Allergy, Asthma & Immunology. 87:457-460 |
| ISSN: | 1081-1206 |
| DOI: | 10.1016/s1081-1206(10)62257-0 |
| Popis: | CASE HISTORY A 9-year-old boy presented to his primary physician for an itchy rash and swelling. He was not symptomatic at the time of the initial visit, and the only finding of note on physical examination was a slightly enlarged spleen. Routine labwork revealed a white blood cell count of 16,000 with 42% eosinophils and an immunoglobulin (Ig)E of 199. An abdominal ultrasound with emphasis on the spleen was normal. He was referred to rheumatology and allergy/immunology for evaluation. There had been no associated wheezing, abdominal pain, laryngeal edema, or stridor. The mother noted that the swelling had occurred on a monthly basis for the past year and usually involved the face, unilaterally or bilaterally. He had been previously evaluated by an otolaryngologist as having recurrent parotid sialoadenitis. These episodes would last a matter of days to a week or two. The swelling was often, but not always, accompanied by fever and/or urticarial papules and plaques on trunk and arms. The mother was uncertain of any significant weight gain or loss. No triggers, such as trauma, food exposures, stress, or medications, could be identified. Antihistamines did not help. There was no history of foreign travel and no family history of similar occurrences or connective tissue disorders. Skin prick testing to multiple common inhalants and foods was negative with appropriate controls. Further laboratory evaluation included the following: negative stool ova and parasites exam; negative Toxocara serology; normal complement studies including functional and quantitative C1 esterase levels, C3, C4, C1Q binding assay, and complement specific immune complexes; rheumatoid factor, fluorescent treponemal antibody/rapid plasma reagin, antinuclear antibody, and antineutrophil cytoplasmic antibodies were negative; normal immunoglobulins with the exception of an IgM level of 975 mg/dL (44 to 247 mg/dL) and IgE, 491 (0 to 150 IU/mL). C-reactive protein was normal, and Westegren sedimentation rate ranged from 30 to 91 mm/hour. Before he returned for followup in the allergy/immunology clinic, his primary care physician noted a new heart murmur. An electrocardiogram was obtained and demonstrated a right bundle branch block. Chest x-ray was normal. |
| Databáze: | OpenAIRE |
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