Quincke's disease of the uvula

A Case of Recurrent Isolated Uvula Oedema Secondary to Obesity and Obstructive Sleep Apnoea

A 34-year-old male presented as an emergency with sudden onset globus, stertor and choking whilst asleep. He had similar previous episodes that self-resolved. The patient's observations were all within normal range. On examination, he had a grossly enlarged, non-erythematous uvula and there were no signs of respiratory distress or stridor. He was managed with intravenous dexamethasone and an attempt at needle aspiration of the uvula was made but there was no clinical improvement in the patient's condition. Despite no improvement with therapy, he was monitored overnight for any signs of airway compromise and discharged the following morning. His symptoms completely resolved on follow-up in the otolaryngology clinic a week later. He was diagnosed with Quincke’s oedema caused by his obesity and background of obstructive sleep apnoea. We discuss the various aetiologies, assessment, and management of Quincke’s oedema.

A Case of Cocaine-Induced Uvular Edema

A 26-year-old male presented to the emergency department with a chief complaint of globus sensation and sore throat in the setting of recent cocaine use. On physical examination, he was found to have isolated uvular edema and erythema. After excluding other potential inciting mechanisms of Quincke's disease, he was treated with anti-inflammatory medication and was observed for any development of airway compromise prior to discharge.

Angioedema - Our Experience Focused On Socio-Demographic, Etiological and Clinical Characteristics of the Condition and Its Management

BACKGROUND:

Angioedema (AE) is acute oedema of the skin and mucous surfaces, involving the respiratory and gastrointestinal tracts. AE could be a life-threatening medical condition. Regardless of its growing clinical importance, many aspects of its aetiology and pathogenesis remain poorly understood. Its incidence, demographic characteristics, diagnosis and therapy, need further investigation.

AIM:

This study reports our experience with angioedema concerning its social and demographic characteristics, aetiology, clinical features, diagnosis and treatment outcomes. Study design: Eighty-eight patients with AE were enrolled. The study is a retrospective analysis of patients treated in our Clinics.

METHODS:

All participants were asked on a voluntary basis to fill out a specially designed questionnaire on the day of their discharge. Other important data sources included: patients’ history and notes during the hospital stay, information from previous admissions, etc. Parametric and non-parametric statistical methods were used for data processing. Data analysis was performed using SPSS (SPSS Inc., IBM SPSS Statistica) version 20.0

RESULTS:

Based on our results, AE affects more frequently patients over 50 years of age, regardless of their sex. Urban residents prevail, among them - more commonly working women. Non-steroidal anti-inflammatory drugs (NSAIDs), hormones and antibiotics were among the most common triggers – in 8%, 4.5% and 11.4% of the cases respectively. In 9.09% of the patients, food-induced AE was seen, the most common foods reported, were – nuts, eggs and egg products. The common sites of involvement were periorbital area and lips. In only 9.1% of the patients, oedema progressed to spread to the upper respiratory tract. Cardiac conditions were the most frequent underlying disorders – 33%, of the patients, auto-immune thyroiditis was the second most common-14.8%, followed by musculo- skeletal disorders (10.2%) and diabetes (4.5%) Family history of allergy was seen in 8.4% of the patients, the most frequent allergic disorder, reported, was asthma. In patients with HAE, family history was present in 2.9% of the patients.

CONCLUSIONS:

All patients received therapy with steroids and antihistamines, resulting in resolution of symptoms and no invasive procedures were necessary. Based on our results, the diagnosis of AE is often difficult and delayed and requires specialist evaluation. If recognised on time and adequately treated, the outcomes are favourable.

Recurrent oedema of the uvula in a patient with chronic spontaneous urticaria successfully treated with omalizumab

Uvula oedema is a condition characterized by a sensation of a foreign body in the oropharynx and difficulty to speak; sometimes, if associated with glottis oedema, difficulty to breathe and dysphonia are also present. Urticaria is a disease characterized by itching wheals on the skin, and sometimes angioedema. Chronic urticaria is spontaneous when the etiology is unknown. Chronic urticaria may be disabling and difficult to treat, with a negative impact on the patient's quality of life. Omalizumab administration is suggested for refractory patients as add-on therapy to the antihistamines, in a third line. In Italy, omalizumab may be used for the treatment of spontaneous chronic urticaria in patients older than 12 years, refractory to antihistamines, with UAS >3 and UAS7 > 16. We describe a case of a 62-year-old woman had had recurring uvula oedema and chronic urticaria, not responder to antihistamines and oral corticosteroids. After 6 months of treatment with omalizumab and antihistamines, no urticaria recurrence was reported and no new episodes of angioedema had occurred. Our experience showed that omalizumab might be effective in patients with recurrent uvula oedema associated with urticaria.

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.

Angioneurotic edema associated with haloperidol

Background. Angioneurotic edema is a life-threatening medical emergency that requires urgent diagnosis and treatment. Haloperidol is in the butyrophenone class of antipsychotic medications. Acute anaphylaxis to Haloperidol is very rare and no cases have been reported in literature. Objective. To report the association of life-threatening angioneurotic edema with intramuscular Haloperidol. Case Report. We present a case of an adult with no known allergies in whom angioneurotic edema with tongue swelling and protrusion developed after the administration of a single IM dose of Haloperidol. Conclusion. We propose angioneurotic edema in a rare side effect of Haloperidol. The onset of the symptoms is abrupt, but it may take 12–36 hours to resolve completely. Therefore patient should be monitored for 12–36 hrs.

[Swollen and elongated uvula after general anaesthesia]

Localized pathological changes of the uvular are rare but potentially life-threatening complications after general anaesthesia with endotracheal intubation. A case of postoperative swollen and elongated uvula after general anaesthesia in a prone position is presented. A mechanical trauma seems to be the most likely etiology.

Parapharyngeal space tumour presenting as recurrent uvular oedema

Neoplasms of the parapharyngeal space are uncommon and usually present as an intra-oral or neck mass. They often elude early diagnosis due to their deep-seated nature. Here we report a case presenting with recurrent oedema of the uvula. The pathophysiology of this previously unreported mode of presentation is discussed.

Sudden drooling and supine gagging: an important emergency?

We describe a case of an eupnoeic patient complaining of a foreign body sensation in his mouth and throat, with sudden drooling and supine gagging. This condition was caused by an isolated uvular angioedema (Quincke's oedema). As this uvular hydrops did not decrease with initial standard therapy for angioedema, epinephrin was applied directly on the swollen uvula, causing it to shrink very rapidly. Isolated uvular oedema is a potentially life-threatening condition with risk of sudden upper airway obstruction, and should therefore be recognized and treated as soon as possible. As described in this case, its initial presentation can consist of gagging and drooling without dyspnoea, thus causing a real challenge for triage and diagnosis.

Life-threatening uvular angioedema caused by Ecbalium elaterium

Ecbalium elaterium, known as the wild or squirting cucumber, is a hairy perennial herbaceous vine of the Cucurbitaceae family, endemic to the Mediterranean region. All parts of the plant are toxic, particularly the gherkin-like fruits. It is frequently used in the treatment of sinusitis by nasal aspiration in some parts of the Mediterranean. The studies regarding to Ecbalium elaterium, argue that it has an anti-inflammatory characteristic. Two cases of uvular oedema have been ascribed to the undiluted use of this substance. Since they can threaten life, similar cases arising with the improper use of herbals should not be ignored in the emergency department. In this paper we present a life-threatening uvular angioedema caused by nasal aspiration of undiluted juice of squirting cucumber.

Conditions of the uvula: a 14 years experience

OBJECTIVE

A retrospective study to find out the aetiology, symptomatology and management of elongated and enlarged uvulae.

MATERIALS AND METHODS

Examination of files of 375 patients seen in the period 1983-1997.

RESULTS

Trauma constituted a big proportion of patients seen. However, papillomas, solitary infections, allergy, simple symptomatic elongation, squamous cell carcinoma as well as asympomatic elongation were seen. The symptomatology varied between simple irritation in the throat to vomiting, pain and dysphagia.

CONCLUSION

Enlarged or elongated uvulae are rare but solitary involvement of uvula because of variety of causes occur.

Simultaneous uvulitis and epiglottitis in adults

The emergency physician must be aware of the varied ways in which epiglottitis can present. This report discusses two adult patients who presented with symptoms and signs indicative of uvulitis who were found to have associated epiglottitis. Neither patient reported respiratory difficulty but both experienced significant pain upon swallowing and were febrile with an enlarged, erythematous uvula. Management consisted of close observation and treatment with an intravenous antibiotic and corticosteroid. The emergency physician should consider the possibility of coexistent epiglottitis in the adult patient who presents with uvulitis.

Simultaneous uvulitis and epiglottitis without fever or leukocytosis

A case is presented of simultaneous uvulitis and epiglottitis in an afebrile patient without elevation in the white blood cell count. This case is reported to illustrate the need for a high index of suspicion for the rare association of uvulitis and epiglottitis.

Angioedema associated with droperidol administration

Angioedema, also known as angioneurotic edema or Quincke's disease, is a well-demarcated, localized edema involving the subcutaneous tissues that may cause upper-airway obstruction. We report the case of a previously healthy 19-year-old man with no known drug allergies in whom angioedema with significant tongue swelling and protrusion developed within 10 minutes of the administration of a single IV dose of droperidol.

Isolated uvular angioedema associated with ACE inhibitor use

Angioedema is a well-known complication of medical therapy with angiotensin-converting enzyme (ACE) inhibitors. Isolated uvular angioedema, a rare presentation of angioedema, in a patient taking lisinopril (Zestril) is described in this case report. Management of uvular edema is also reviewed.

Clinical characteristics of acute uvulitis

Previous literature has identified uvulitis as a condition with serious implications. This report details a series of 15 patients with uvulitis whose clinical features were remarkable for a relatively benign course. This is the largest series of patients with uvulitis in the literature. The predominant symptoms were related to sore throat and pain or difficulty on swallowing. No patient had significant airway or infectious complications attributable to the uvulitis. The only patient admitted to the hospital required management of an associated peritonsillar abscess. Of the 14 patients discharged, 13 (93%) were followed-up and none required further care. Seven (50%) of the discharged patients received symptomatic treatment only, whereas the others were treated with medications including antibiotics, corticosteroids, diphenhydramine, and B-agonists. Further research into the etiology and management of uvulitis is warranted.

Quincke's disease: nonhereditary angioneurotic edema of the uvula

We report two cases of Quincke's disease, an isolated form of angioneurotic edema involving the uvula that is induced by several factors, including foods, drugs, and inhalants. Although Quincke's disease has prominent oral manifestations, it has only rarely been described in the dental literature. The rapid onset and progression of the disorder, combined with the risk of respiratory compromise, may result in a serious medial emergency. Clinical manifestations include a nonerythematous swollen uvula, fullness in the throat, and signs of airway obstruction. A hereditary form of angioneurotic edema is associated with a biochemical defect; this must be differentiated from nonhereditary, localized forms such as Quincke's disease to determine appropriate treatment and predict prognosis. Clinical features and laboratory tests can distinguish hereditary angioneurotic edema from the nonhereditary form.

Evaluation and management of acute uvular edema

Acute uvular edema is a potentially life-threatening condition with a variety of causes. Other upper airway structures, most notably the epiglottis, may also become involved, and complete or partial airway obstruction may ensue rapidly. An accurate diagnosis may be essential in establishing effective treatment.

Adult and pediatric pharyngitis: a review

Acute pharyngitis is frequently encountered in the ambulatory care setting. Although usually of viral etiology, streptococcal disease is the focus of diagnostic efforts, in light of significant suppurative and nonsuppurative sequelae. The traditional symptoms of fever, adenopathy, and pharyngeal exudate are suggestive, but not diagnostic of streptococcal pharyngitis. Thus, the importance of diagnostic testing, including Group A beta hemolytic strep antigen screen and culture, is emphasized. Recent innovations in therapy include modification of antibiotic dosing regimens and use of cephalosporins to improve patient compliance.

Glossal abscess

A 21-year-old man presented to our emergency department with a two-day complaint of painful swelling and protrusion of the tongue, odynophagia, dysphagia, and difficulty with speech. A nonfluctuant area of tongue swelling was identified; needle aspiration of this site produced 5 mL of pus, with considerable amelioration of symptoms. Culture of the aspirate subsequently grew Hemophilus parainfluenzae, the first such reported case of this pathogen in a glossal abscess. Glossal abscess is a rare clinical entity that may result in airway compromise and disseminated infection to other systems. The presence of a glossal abscess should be considered in all cases of tongue swelling.