3085 Angioedema with Eosinophilia: The First Report from Thailand

Friday, 16 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Thatchai Kampitak, MD , Medicine, Samitivej Sukhumvit Hospital, Bangkok, Thailand

Background: Angioedema with eosinophilia (AE) is an uncommon form of angioedema. Although its pathogenesis remains unclear, it can be classified into episodic angioedema with eosinophilia (EAE) and nonepisodic angioedema with eosinophilia (NEAE). While EAE has been generally observed in the Western populations, almost all patients with NEAE were Asian, exclusively Japanese and Korean. Previously, AE has never been reported in Thai patients.

Methods:  A case series of 3 patients with AE from Thailand is described.

Results: Three Thai patients with AE were identified during April 2014-March 2015. All but 1 patient were female. The mean age at the onset of symptoms was 32 years (27-39). All patients presented with symmetrical swelling of distal extremities without systemic symptoms. No fever or weight gain was observed. Arthralgia and urticaria were present in 1 patient, respectively.  No potential triggers were identified except 1 patient had preceding upper respiratory tract infection 1 week prior to the swelling. Previous history of significant medical or allergic diseases was unremarkable in all except 1 patient was hepatitis B carrier and had recurrent eczema.  All patients had eosinophilia with the mean eosinophil count of 4,083/mm3 (1,006-9,420). Blood chemistries, liver and kidney function tests, inflammatory markers (ESR and CRP) and immunoglobulin levels were within the normal ranges in all patients. Secondary disorders that might be responsible for eosinophilia were excluded. Recurrent episodes of angioedema were observed in 1 patient. Antihistamine was briefly prescribed in 1 patient with coexisting urticaria. All patients had complete spontaneous resolution of symptoms in parallel with the normalization of eosinophil count within few months after the presentation.

Conclusions: AE should be considered in young Asian women whose presenting features include peripheral swelling and eosinophilia without constitutional symptoms, internal organ involvement and elevated immunoglobulin levels. Similar to previous reports from Japan and Korea, NEAE is more prevalent in Thai patients than EAE. No corticosteroid therapy is generally required since most patients have a self-limiting disease.