Prepared by David E. Winchester, MD, Resident, Department of Internal Medicine, and Margaret L. Plews-Ogan, MD, MS, Associate Professor and Division Head of General and Geriatric Medicine, University of Virginia Health System, Charlottesville

A hypertensive, diabetic 68-year-old black woman presented to the emergency department with the chief complaint of facial, labial, and tongue swelling (Figure). Her symptoms have been worsening over the last few hours. (About 4 months ago, she had had a similar episode, and the symptoms resolved spontaneously.) The patient and her family reported no known food allergies or insect bites or stings, no recent changes in her diet, and no family history of similar symptoms. The patient had no urticarial lesions. She said she was allergic to “sulfa” but had not started any new medicines lately. Her hypertension and diabetes were controlled with oral medications, although she could not recall their names. Laboratory studies were unremarkable.

What’s Your Diagnosis?
Arthropod envenomation

C1-inhibitor deficiency

Drug-induced angioedema

Peanut allergy