AN UNCOMMON CAUSE OF LIP SWELLING

Abstract

<h3>Introduction</h3> Angioedema is a common presentation in allergy clinic. Typical etiologies include mast cell mediated, bradykinin mediated, and idiopathic angioedema. It is important to consider less common causes and conditions that masquerade as angioedema. <h3>Case Description</h3> A 14-year-old male presented with persistent lower lip swelling. Medical history was notable for asthma, urticaria, allergic rhinitis, atopic dermatitis, and constipation. Examination showed asymmetric lower lip swelling without involvement of the tongue, uvula, or other area of the face. Laboratory work-up for suspected angioedema revealed normal CBC, elevated ESR, and normal C1 esterase inhibitor and C1 function. He tried cephalexin, mupirocin, cetirizine 20mg daily, montelukast, prednisone 50mg for 5 days and elimination of all product use on lips except for Vaseline without resolution of angioedema. A lip biopsy was obtained which revealed granulomatous cheilitis. The patient was referred to gastroenterology. Colonoscopy demonstrated granulomatous colitis and ileitis consistent with Crohn's Disease. Lip swelling resolved with adalimumab. <h3>Discussion</h3> While allergic and immunologic pathology are common causes of angioedema, this case encourages consideration of other etiologies of lip swelling, such as inflammatory bowel disease. Other diagnoses to consider include sarcoidosis, infections, miescher's cheilitis, and autoimmune conditions.