Angioedema caused by prednisolone – a very rare constellation

Angioedema is frequent entity in emergency patients and is differentiated by mediation by histamine versus bradykinine, which positions the treatment regime. In cases of drug reaction both types can cause the disease.

Case presentation:

A 75 years old male patient presents with acute facial swelling and consecutive expansion to the hypopharynx after first intake of 40 mg prednisolone the previous evening due to a rheumatic disease. The administration of antihistamines leads to moderate improvement. After admission for surveillance, on the following day the patient receives controlled infusion of prednisolone with slow flow rate with abruption after relapse of hypopharyngeal swelling. In between a few hours the patient showed a physiologic state.

Lab exams show normal values for total and specific IgE, CRP, functional and chemical C1-INH as well as C3/C4 complement factors. ECP and neutrophil granulocytes are elevated and macrocytic hyperchromic anemia is found. Hence, angioedema triggered by histamine is suspected in our patient.

Conclusion:

This case shows a very rare constellation of an anaphylactic reaction on prednisolone. Regularly antihistamines and steroids are given in emergency angioedema treatment, which in patients like ours may lead to instant und possibly deleting impairment. In situations like these, the next step after application of antihistamines should be the use of adrenalin in addition to equipping the patient with an adequate emergency medication set and an emergency card.

Publication History

Publication Date:
18 April 2018 (online)