Fresh Frozen Plasma Beneficial for ACE Inhibitor?Induced Angioedema
To the Editor: The article "Atypical Presentation of ACE Inhibitor?Induced Angioedema" (October 2007) was interesting. At the Mercy Hospital of Pittsburgh, we admitted a similar case to the intensive care unit through the emergency department.1 Our patient was initially treated with antihistamines and steroids. After receiving 2 units of fresh frozen plasma, her symptoms improved significantly, and she was able to go home the very next day. It is now believed that the kininase activity in the fresh frozen plasma is responsible for breaking down the accumulated bradykinin in patients suffering from angiotensin-converting?enzyme inhibitor?induced angioedema, and that helps resolve the symptoms.
Lubna Mirza, MD
Internal Medicine
Mercy Hospital of Pittsburgh, Pa.
1. Warrier MR, Copilevitz CA, Dykewicz MS, et al. Fresh frozen plasma in the treatment of resistant angiotensin-converting enzyme inhibitor
angioedema. Ann Allergy Asthma Immunol. 2004;92:573-575.
Rethinking Ethnicity in Thyrotoxic Periodic Paralysis
To the Editor: We would like to comment on the case report "Hypokalemic Thyrotoxic Periodic Paralysis" (July/August 2007). Although until now it has been accepted that thyrotoxic periodic paralysis is more common in Asians, this condition has also been described sporadically in white, Hispanic, and African-American patients, as is described in this case presented by Drs Dahal and Roy. Thyrotoxic periodic paralysis can indeed be a presenting symptom of thyrotoxicosis. We recently reported on 3 cases involving African Americans who presented with acute weakness and hypokalemia: 2 of them were diagnosed with Grave?s disease and thyrotoxic periodic paralysis (using biochemical laboratory testing and thyroid radioactive iodine uptake scan). The third patient was diagnosed with thyroiditis (using biochemical hyperthyroid). With the current state of international travel and the resulting increase in population migration, what was previously thought of as an uncommon disease entity in this country must now be considered in tients of any ethnic origin presenting with hypokalemia (ie, <3 mEq/dL) and muscle weakness. Thyroid function tests should be considered in all such patients, regardless of their ethnic background.
Naveen Thota, MD
Internal Medicine
Wright State University Boonshoft School of Medicine
Dayton, Ohio
Jelly Belly Diagnosis
To the Editor: Thank you for the wonderful entry presented in the Picture Perfect entry in the November/December 2007 issue. I am reminded of a patient, now long deceased, who presented with a mammoth abdominal girth associated with his belly scar and weight loss. When asked ?What have you been told was the diagnosis,? he took out a piece of paper from his wallet, on which was penciled in, "Pseudomyxoma Peritonei," which was referred to as "Jelly Belly" by our professor of pathology, exactly as described in the present case.
Joshua Grossman, Col., MD
US Army Medical Corp
