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Make the Dx: New mom, new swelling

MDlinx Nov 23, 2023

Can you diagnose this mystery illness?

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.

She is treated with an antihistamine and released. 

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. 

One day later, she returns to the emergency department with the same complaints. 

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.” 

Of the likely differential diagnoses for this patient, which would you identify as most concerning?

Click here for the solution.

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