DOI: 10.12890/2022_003671
Non-Episodic Angioedema Associated with Eosinophilia after COVID-19
Authors
mornak14@gmail.com
Keywords
COVID-19, non-episodic angioedema with eosinophilia, non-pitting oedemaAbstract
ntroduction: Non-episodic angioedema associated with eosinophilia (NEAE) has been reported primarily in young East Asian women and is characterized by a single episode of persistent limb oedema, peripheral eosinophilia, and transient joint pain. Although there are reports of eosinophilia disease after coronavirus disease 2019 (COVID-19), the occurrence of NEAE has not been previously reported.
Case description: A 29-year-old Japanese woman, with a history of allergic rhinitis and atopic dermatitis, sought a medical consultation for persisting oedema of the extremities, which developed about 2 weeks after she contracted COVID-19. Physical examination revealed symmetrical non-pitting oedema with peripheral predominance. Laboratory examination revealed a blood eosinophil count of 7536/µl. The patient was diagnosed with NEAE and a 7-day course of prednisolone (15 mg/day) was initiated, with rapid improvement in the oedema and no recurrence on follow-up.
Discussion: The exact aetiology of NEAE is unknown, but it may develop after infection or drug exposure. Eosinophilic disease after COVID-19 infection has been reported and, therefore, eosinophilic angioedema should be considered in the differential diagnosis of non-pitting oedema of the extremities after a COVID-19 infection. Early diagnosis of NEAE is important as rapid improvement can be achieved with low-dose steroid treatment.
Conclusion: NEAE can develop after COVID-19 and should be considered in the differential diagnosis of non-pitting oedema of the extremities.
References
- Chikama R, Hosokawa M, Miyazawa T, Miura R, Suzuki T, Tagami H. Nonepisodic angioedema associated with eosinophilia: report of 4 cases and review of 33 young female patients reported in Japan. Dermatology 1998;197:321–325.
- Goto K, Ishizaki S, Tanese K, Oshitani Y, Kaku Y, Kaneko R, et al. Histological classification and differential diagnosis of nonepisodic angioedema with eosinophilia: a clinicopathologic study of 12 cases with literature review. Am J Dermatopathol 2016;38:124–130.
- Kampitak T. Nonepisodic angioedema with eosinophilia: a case series from Thailand. Allergol Int 2017;66:510–511.
- Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician 2013;88:102–110.
- Ishizuka K, Katayama K, Kaji Y, Tawara J, Ohira Y. Non-episodic angioedema with eosinophilia after BNT162b2 mRNA COVID-19 vaccination. QJM 2021;114:745–746.
- Shikino K, Hirose Y, Nakagawa S, Ikusaka M. Non-episodic angioedema associated with eosinophilia. BMJ Case Rep 2016;2016:bcr2016217428,
- Descalzo V, Salvador F, Sansano I, Persiva Ó, Antón A, Clofent D, et al. Acute eosinophilic pneumonia associated with SARS-CoV-2 infection. Arch Bronconeumol 2021;57:50–52.
- Batarseh E, Kersten BP, Pinelo AC, Nadler JN, Schwartz SA. Angioedema in African American patients hospitalized for COVID-19. Am J Respir Crit Care Med 2020;202:1581–1584.
- Manzano JMM, Ysea-Hill O, Chiang B, Jarrett SA, Lo KB, Azmaiparashvili Z. Coronavirus disease-19 infection and angioedema in African Americans: a case series. Otolaryngol Case Rep 2022;24:100457.
- Cho HJ, Yoo HS, Kim MA, Shin YS, Ye YM, Nahm DH, et al. Clinical characteristics of angioedema with eosinophilia. Allergy Asthma Immunol Res 2014;6:362–365.
- Karampoor S, Afrashteh F, Rahmani S, Laali A. Eosinophilic granulomatosis with polyangiitis after COVID-19: a case report. Respir Med Case Rep 2022;38:101702.
- Lyons-Weiler J. Pathogenic priming likely contributes to serious and critical illness and mortality in COVID-19 via autoimmunity. J Transl Autoimmun 2020;3:100051.
- Notomi K, Harada T. Achenbach syndrome. CMAJ 2019;191:E584.
