Clinician’s Corner
Case 1: Recurrent abdominal pain in an adolescent girl
A
12-year-old girl presented to the emergency department with a three-day history of worsening, colicky periumbilical and lower abdominal pain. Associated symptoms included anorexia, nausea and nocturnal awakening. This was preceded by two days of upper respiratory tract infection symptoms including malaise, cough and fever. Vital signs demonstrated fever (38.8°C), tachycardia (heart rate 148 beats/min) and tachypnea (respiratory rate 28 breaths/min), but normal blood pressure and oxygen saturation on room air. Abdominal examination demonstrated tenderness in the mid and left lateral abdomen, with palpable fullness in the left lower quadrant. Elevated white blood cell count (15.7×109/L), platelet count (426×109/L), C-reactive protein level (17 mg/L [161.9 nmol/L]), erythrocyte sedimentation rate (16 mm/h) and normal serum albumin were noted. Abdominal ultrasound identified marked ascites and isolated bowel wall thickening of the sigmoid colon. The patient was admitted for observation. Gastroenterology and Pediatric Surgery were consulted regarding the abdominal pain and ultrasound findings. On further history, it was discovered that the patient had a five-year history of stereotypical recurrent abdominal pain. These episodes were much milder than at the time of presentation, and they occurred up to twice per month, resolving spontaneously within two days. Further history suggested the underlying diagnosis.
Correspondence (Case 1): Dr Alfred K Yeung, Alberta Children’s Hospital, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8. Telephone 403-955-3071, fax 403-955-2922, e-mail [email protected] Case 1 accepted for publication November 19, 2013.
Paediatr Child Health Vol 19 No 5 May 2014
©2014 Pulsus Group Inc. All rights reserved
233
Clinician’s Corner
CASE 1 DIAGNOSIS: Hereditary angioedema
Family history was significant for hereditary angioedema (HAE) in the patient’s mother and brother. Both experienced recurrent episodes of swelling of the face and extremities in addition to abdominal pain. HAE was not initially suspected in our patient due to the absence of associated facial or extremity swelling during her pain episodes. Her abdominal pain improved significantly within 24 h and she was discharged. Complement assays revealed normal C3 (1.73 g/L), low normal C4 (0.13 g/L), decreased C1 esterase inhibitor (C1INH) (0.07 g/L) and low C1 esterase inhibitor (C1INH) functional activity (
Case 1: Recurrent abdominal pain in an adolescent girl
A
12-year-old girl presented to the emergency department with a three-day history of worsening, colicky periumbilical and lower abdominal pain. Associated symptoms included anorexia, nausea and nocturnal awakening. This was preceded by two days of upper respiratory tract infection symptoms including malaise, cough and fever. Vital signs demonstrated fever (38.8°C), tachycardia (heart rate 148 beats/min) and tachypnea (respiratory rate 28 breaths/min), but normal blood pressure and oxygen saturation on room air. Abdominal examination demonstrated tenderness in the mid and left lateral abdomen, with palpable fullness in the left lower quadrant. Elevated white blood cell count (15.7×109/L), platelet count (426×109/L), C-reactive protein level (17 mg/L [161.9 nmol/L]), erythrocyte sedimentation rate (16 mm/h) and normal serum albumin were noted. Abdominal ultrasound identified marked ascites and isolated bowel wall thickening of the sigmoid colon. The patient was admitted for observation. Gastroenterology and Pediatric Surgery were consulted regarding the abdominal pain and ultrasound findings. On further history, it was discovered that the patient had a five-year history of stereotypical recurrent abdominal pain. These episodes were much milder than at the time of presentation, and they occurred up to twice per month, resolving spontaneously within two days. Further history suggested the underlying diagnosis.
Correspondence (Case 1): Dr Alfred K Yeung, Alberta Children’s Hospital, 2888 Shaganappi Trail Northwest, Calgary, Alberta T3B 6A8. Telephone 403-955-3071, fax 403-955-2922, e-mail [email protected] Case 1 accepted for publication November 19, 2013.
Paediatr Child Health Vol 19 No 5 May 2014
©2014 Pulsus Group Inc. All rights reserved
233
Clinician’s Corner
CASE 1 DIAGNOSIS: Hereditary angioedema
Family history was significant for hereditary angioedema (HAE) in the patient’s mother and brother. Both experienced recurrent episodes of swelling of the face and extremities in addition to abdominal pain. HAE was not initially suspected in our patient due to the absence of associated facial or extremity swelling during her pain episodes. Her abdominal pain improved significantly within 24 h and she was discharged. Complement assays revealed normal C3 (1.73 g/L), low normal C4 (0.13 g/L), decreased C1 esterase inhibitor (C1INH) (0.07 g/L) and low C1 esterase inhibitor (C1INH) functional activity (
