Isolated non-hereditary angioneurotic oedema of uvula (Quincke's disease) in an adolescent.
A 19-year-old primipara woman was admitted in labour with positive vaginal swab for group B Streptococcus and given benzylpenicillin and ranitidine. She used Entonox for pain relief. She received bupivacaine in the epidural catheter and shortly after developed sensation of foreign body in her throat with muffled voice and isolated angioneurotic oedema of the uvula. She responded well to H1 and H2 histamine blockers and steroids and epinephrine were kept as standby. She recovered well soon after delivery. Penicillin, Entonox or bupivacaine seemed possible cause of the Quincke's disease. Hereditary form was ruled out by normal creatine kinase and reaction to bupivacaine by C1 esterase inhibitor assay. It can be associated with spectrum of anaphylactic reactions and the resuscitation team should be alerted. Airway maintenance should be the primary management strategy. Most cases respond to observation, oxygen therapy and antihistamines with or without steroids. Epinephrine may be required occasionally.
Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Ramnik V
RV
Patel
Cho
C
Cho
Christopher
C
Medd
Janet
J
Cresswell
D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy; D000777:Anesthetics / Q000009:adverse effects* / Q000627:therapeutic use; D000799:Angioedema / Q000139:chemically induced* / Q000188:drug therapy; D054179:Angioedemas, Hereditary; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009609:Nitrous Oxide / Q000009:adverse effects / Q000627:therapeutic use; D010100:Oxygen / Q000009:adverse effects / Q000627:therapeutic use; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D014609:Uvula; D055815:Young Adult
D000777:Anesthetics; D000900:Anti-Bacterial Agents; D010406:Penicillins; C001147:Entonox; D009609:Nitrous Oxide; D010100:Oxygen; D002045:Bupivacaine