Swelling appears and disappears on and off for past 3-4 months. Swelling usually develops in the morning and subsides in 4-8 hrs on the same day. His TC,DC and ESR : WNL
What can it be?
I Can think only of some type of allergy. Tooth paste can produce such condition. Angiotic or angioneurotic edema manifestations are similar.
even I thought in terms of angioneurotic edema
patient reports no change of habits or use of new products.
Only aspect that goes against angioneurotic edema is duration. The time of disappearance is from 2 to max 8 hrs. Avg 2-4 hrs.
It also could be a manifestation of a granulomatosis (crohn, miescher, sarcoïdosis ...)
Sorry, but what means TC, DC, ESR and WNL ? I'm not fluent in english.
Hi, I have some additional questions:
1. Does the swelling appear without irritation and in a specific time?
2. Does it resolves without any medication?
3. Does the patient complained of pain during swelling?
4. Is there any family history.
This seems like very unusual and uncommon symptom for me. Thanks
I'm inclined to agree with the provisional diagnosis of an allergic manifestation. Ask him to try and change his current toothpaste and see if it still recurs. Could be a reaction to the foaming component of the paste i.e. Na laurylsulfate. May be try a non-foaming toothpaste. Angioedema is another probability. Granulomatosis is highly unlikely as the current lesion disappears and recurs on a frequent basis.
Needs a better description of the swelling. exact location/s, type of swelling and accompanying local symptoms (urticaria, redness, induration, local lymph glands etc.). Has there been any recent changes in food and oral hygiene habits and oral hygiene aids?
I think Allergies, Angioedema ( Hereditary or Acquired) , Melkerssonal-Rosenthal Syndrome, Crohn and sarcoidois are top in the list of differential Diagnoses . Biopsy can be helpful .
All this is inclining me towards allergy, most probably to toothpaste or some food.
Patient responded to a course of : levocetrizine
He is under observation!!
Excellent , As i told you before, Most likely it is of allergy background, please make a thorough history and observe , you might find the trigger material
That's great, Dr. Bhargava! It is indeed a relief to us as much as it must be for you and the patient. Like Al-Khawalde suggested, you just might be able to elicit the trigger allergen. We'll wait n watch..... Nothing on the toothpaste front???
Please consider discussing with a hematologist because it can be vasculitis or microhaemangioma which i have seen in my surgical practice .I have done a MRA a magnetic resonance angiogram and identified the feeding vessel from the superficial temporal artery. cheek subsided after ligation of feeding vessel and lips we did injection of warm saline coupled with hot compresses and vasculitis medical treatment.so consider ruling out microangiopathy which is caused by inflammation of the blood vessels by a trigger factor like allergy or inflammation.
what you describe is Something that may be related to abnormal lymphatic drainage that make lymph accumulates in face while patient in supine during sleep and will get drained gradually when the head is elevated • such Abnnormalities have been reported in early lymphoma patients which l hope is not the case with your patient but it is worth sending your patient to be assessed for that•
I'm agree with allergic reaction or agioedema.The source should be find by the patient,a drug,new toothpaste or ...