A case of hereditary angioedema in a 7-year-old korean girl

Angioedema in a 9-year-old Child after Dental Treatment: A Rare Complication Explored through a Case Report

Aim and background

Angioedema is a nonpruritic swelling that typically affects the skin, mucous membranes of the face, and perioral soft tissues. It can be life-threatening, but it is usually not and can be treated conservatively unless the airway is compromised. This paper seeks to illuminate a rare case of hereditary angioedema (HAE) onset following dental procedures in a 9-year-old Indian boy.

Case description

A 9-year-old male patient reported a chief complaint of spacing in the upper anterior region, which was diagnosed to be due to impacted supernumeraries. Two days after the oral surgical procedure, the child developed symptoms of periorbital edema with facial swelling. A second episode occurred a day after the delivery of the orthodontic appliance. This was also associated with facial swelling, respiratory distress, and gastrointestinal (GI) symptoms. A diagnosis of angioedema was confirmed and was treated appropriately.

Conclusion

Dental professionals must be aware of the possibility of triggering AE, a potentially fatal condition in patients. This case highlights the importance of comprehensive medical history intake and timely physician collaboration when confronting unexpected symptoms following a dental procedure.

Clinical significance

Awareness of rare conditions like HAE can aid dental professionals in early identification and appropriate management, preventing dangerous exacerbations and contributing to safer dental care.

How to cite this article

Barman KS, Ephraim R, Shivashankarappa PG, et al. Angioedema in a 9-year-old Child after Dental Treatment: A Rare Complication Explored through a Case Report. Int J Clin Pediatr Dent 2024;17(11):1285-1288.

Clinical Features of Hereditary Angioedema in Korean Patients: A Nationwide Multicenter Study

BACKGROUND

Hereditary angioedema (HAE) is a genetically heterogeneous autosomal dominant disorder characterized by recurrent episodes of nonpruritic, nonpitting edema increasing after puberty. It can be fatal due to laryngeal or gastrointestinal (GI) involvement with varied and changing frequency of mortality according to studies published from the Western countries. Epidemiological and clinical data of HAE in Asian countries are sparse. We sought to examine the clinical characteristics of HAE patients in Korea.

METHODS

Patients diagnosed with HAE at 15 tertiary hospitals across the country until 2016 were retrospectively reviewed.

RESULTS

A total of 65 patients diagnosed with HAE by 2016 were identified. The prevalence of HAE was estimated at 1.3/1,000,000 in Korea. Of the 65 patients, 21 (32.3%) were males. A total of 90.8% patients had type I HAE, while the remaining 9.2% patients had type II HAE. The first symptom developed after 20 years in 73.8% of patients, with a mean age 28.4 ± 14.1 years. The age at diagnosis was 36.5 ± 15.8 years, with a mean time delay of 7.8 ± 10.5 years. While the face (82.3%) and extremities (upper 71.0%, lower 62.9%) were the most frequently involved, the GI tract was affected in 40.5% of Korean HAE patients. Prophylaxis was maintained in 62.5% of patients. There was no reported case of death from HAE so far.

CONCLUSIONS

The clinical manifestation and severity of HAE may vary according to ethnicity. HAE is more infrequent and GI involvement is less likely in Korea compared with Western countries.

A Case of Type 2 Hereditary Angioedema With SERPING1 Mutation

Hereditary angioedema is a disease of congenital deficiency or functional defect in the C1 esterase inhibitor (C1-INH) consequent to mutation in the SERPING1 gene, which encodes C1-INH. This disease manifests as recurrent, non-pitting, non-pruritic subcutaneous, or submucosal edema as well as an erythematous rash in some cases. These symptoms result from the uncontrolled localized production of bradykinin. The most commonly affected sites are the extremities, face, gastrointestinal tract, and respiratory system. When the respiratory system is affected by hereditary angioedema, swelling of the airway can restrict breathing and lead to life-threatening obstruction. Herein, we report a case of a 24-year-old woman with type 2 hereditary angioedema who presented with recurrent episodic abdominal pain and swelling of the extremities. She had no family history of angioedema. Although her C4 level was markedly decreased (3.40 mg/dL; normal range: 10-40 mg/dL), she presented with a very high C1-INH level (81.0 mg/dL; normal range: 21.0-39.0 mg/dL) and abnormally low C1-INH activity (less than 25%; normal range: 70%-130%). The SERPING1 gene mutation was confirmed in this patient. She was treated with prophylactic tranexamic acid, as needed, and subsequently reported fewer and less severe episodes. To our knowledge, this is the first reported case of type 2 hereditary angioedema in Korea that was consequent to SERPING1 mutation and involved a significantly elevated level of C1-INH as well as a low level of C1-INH activity.