A case report of nonepisodic angioedema with eosinophilia in a Korean patient and a review of the Korean literature
A 26-year-old Korean woman presented with edema of her hands and lower legs, which had developed 2 weeks prior to her hospital visit. Her body weight had increased by 2 kg over those 2 weeks, and this was her first episode of the reported symptoms. The edema was distributed symmetrically on both of the patient's upper and lower extremities, and was pitted. She denied any febrile sensation and had a pruritic rash on her lower legs (), and had also experienced mild joint pain in both knees 1 week after the onset of the edema. Her family and past medical histories, including any allergic diseases, were unremarkable. She also denied taking any drugs, including Oriental medications, with the exception of one acetaminophen tablet (300 mg) 1 week prior to the onset of edema. Her symptoms did not appear to be related to her menstrual cycle.\nLaboratory tests revealed leukocytosis (12,250/mm3; normal range: 4,000-10,000/mm3) with 51.5% eosinophils (normal range: 0~7%) in the peripheral blood. The eosinophil count was 6,300/mm3. Serum IgE had increased to 1,423 IU/mL (normal range: 0-170 IU/mL), but IgA, IgG, and IgM levels were all within normal limits. Antinuclear antibody was negative, as were stool ova and serum antibodies to parasites. No clinical findings were suggestive of autoimmune disease or parasite infestation. No abnormal findings were observed in the serum chemistry that would be reflective of renal or hepatic dysfunction. No proteinuria was detected. The rash on the patient's lower legs was examined histologically, and identified as perivascular eosinophil infiltration (). Lymphocyte phenotyping was conducted, but did not indicate the presence of any abnormal lymphocyte clones.\nWe diagnosed the patient with NEAE, and prescribed an oral antihistamine to control the pruritus. One week after the patient began taking antihistamines, the edema and rash began to evidence improvements. The knee arthralgia also clearly improved. The eosinophil count decreased to 1,530/mm3 after 2 weeks and to 736/mm3 after 8 weeks. The patient was free of symptoms at 4 months, and had an eosinophil count of 550/mm3. We followed the patient for 18 months, and observed no recurrence of either the symptoms or the eosinophilia (the eosinophil count was 180/mm3).