HEREDITARY ANGIOEDEMA PRECIPITATED BY CONSTIPATION SECONDARY TO STIMULANT MEDICATION USE

Abstract

Introduction Hereditary angioedema (HAE) is an inherited condition manifesting as recurrent episodes of swelling that commonly affects the skin and gastrointestinal tract (1,8). Various triggers can be the precipitating factors in an acute episode of HAE, however, sometimes the culprit cannot be determined. Case Description We present a patient with a diagnosis of hereditary angioedema, concomitant ADHD, with recurrent gastrointestinal exacerbations. Within 3 years, he had nine presentations to the emergency room, four related to abdominal pain, and the remainder for swelling alone. All presentations with abdominal pain had documentation indicating patient had not had a bowel movement for several days. He had abdominal ultrasounds showing thickened bowel loops and small amount of ascites, indicating likely hereditary angioedema attack with gastrointestinal involvement. HAE attacks became more frequent following initiation of stimulant medication for ADHD. It is hypothesized that these frequent attacks were exacerbated by constipation secondary to stimulant medication use, and upon discontinuation of medication, he has not presented to the ER with further abdominal crisis. Discussion HAE may present as recurrent episodes of swelling in one or more body parts, but should also be suspected when there are recurrent bouts of abdominal pain with or without emesis. Constipation, a common presenting pediatric complaint, can lead to stress on the body and result in an HAE acute attack (3,7). We are presenting this case for health care providers to consider stimulant medication as a cause of constipation in patients with HAE presenting with abdominal crisis. Hereditary angioedema (HAE) is an inherited condition manifesting as recurrent episodes of swelling that commonly affects the skin and gastrointestinal tract (1,8). Various triggers can be the precipitating factors in an acute episode of HAE, however, sometimes the culprit cannot be determined. We present a patient with a diagnosis of hereditary angioedema, concomitant ADHD, with recurrent gastrointestinal exacerbations. Within 3 years, he had nine presentations to the emergency room, four related to abdominal pain, and the remainder for swelling alone. All presentations with abdominal pain had documentation indicating patient had not had a bowel movement for several days. He had abdominal ultrasounds showing thickened bowel loops and small amount of ascites, indicating likely hereditary angioedema attack with gastrointestinal involvement. HAE attacks became more frequent following initiation of stimulant medication for ADHD. It is hypothesized that these frequent attacks were exacerbated by constipation secondary to stimulant medication use, and upon discontinuation of medication, he has not presented to the ER with further abdominal crisis. HAE may present as recurrent episodes of swelling in one or more body parts, but should also be suspected when there are recurrent bouts of abdominal pain with or without emesis. Constipation, a common presenting pediatric complaint, can lead to stress on the body and result in an HAE acute attack (3,7). We are presenting this case for health care providers to consider stimulant medication as a cause of constipation in patients with HAE presenting with abdominal crisis.