A 19-year-old primigravida woman presents to the emergency department because of facial swelling and respiratory complaints 3 days after an uncomplicated vaginal delivery at term. She is healthy and takes no medications. 

The physical examination is unremarkable; laboratory results are consistent with parturition.

The next day, she returns to the emergency department with the same complaint of facial/lip swelling; however, she has no respiratory complaint. She reports that the antihistamine had provided mild but transient relief. 

Physical examination is again unremarkable; laboratory results remain unchanged. She is reassured and discharged to home. 

The third healthcare provider to evaluate her was not only concerned about the multiple visits, but agreed that facial/lip edema was present. Further history discloses the patient had an uncle who died at age 40 years due to a “respiratory problem.” 

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