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BACKGROUND
A 45-year-old man presents to the emergency department with swelling of the tongue that started about 30 minutes before his arrival. The patient denies having shortness of breath, a sore throat, drooling, or globus sensation. He also denies ingestion of new foods, pills, or supplements and any exposure to new items such as soap, tooth paste, deodorants, and laundry detergents. The patient is not taking any medications and is allergic to penicillin. He reports a history of urticaria and 1 episode of an allergic facial swelling that was successfully treated with antihistamines and steroids.
On physical examination, the patient's vital signs are a temperature of 37.2°C, blood pressure of 140/67, heart rate of 77 beats per minute, respiratory rate of 18 breaths per minute, and an O2 saturation of 99% while he is breathing room air. The patient appears well and is in no acute distress. Head, eyes, ears, nose, and throat examination reveals marked swelling of the right side of the tongue and the floor of his mouth (see Image). Of note, the patient has no difficulty opening his mouth, and the floor of his mouth is soft to palpation. The uvula is visualized by using a tongue depressor; it is midline and not swollen.
The lungs are clear to auscultation without any wheezing or rales, and hearts sounds are regular and without murmurs. The abdomen is soft and not tender. The extremities show no signs of cyanosis or edema. Detailed skin examination fails to demonstrate any abnormal lesions; in particular, no urticarial lesions are identified.
What is the diagnosis?
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Hint
This is an uncommon presentation of a relatively common bilateral phenomenon.
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Author:
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Gil Z. Shlamovitz, MD,
Department of Emergency Medicine,
UCLA/Olive View-UCLA Emergency Medicine Residency Program,
David Geffen School of Medicine at UCLA, Calif
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eMedicine
Editor:
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Rick G. Kulkarni, MD,
Assistant Professor,
Yale School of Medicine,
Section of Emergency Medicine,
Department of Surgery,
Attending Physician,
Medical Director,
Department of Emergency Services,
Yale-New Haven Hospital, Conn
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