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Quincke's Disease by Alprazolam: A Case Report

Pedro Miguel Marques Gomes, Andre Carcao, Joana Borges Costa, Delfim Duarte, Paula Azevedo

AAngioedema corresponds to a self-limited edema, located on the skin or mucosa, which results from leakage of fluid into the interstitium, caused by a loss of vascular integrity. It can occur isolated, as in angioedema of the uvula, or as part of an anaphylactic reaction. Isolated uvula angioedema, or Quincke's disease, is a rare clinical entity with multiple reported etiologies. The presentation of this clinical case aims to raise awareness of a rare diagnosis that can be deadly. In the case presented it is suspected that the aetiological agent is pharmacological: an allergic reaction to alprazolam. A 56-year-old man was admitted in the emergency department with oropharyngeal foreign body sensation and dysphagia after taking alprazolam. On examination of the oral cavity there was marked edema in the uvula, with visualization of the posterior wall of the oropharynx. The patient had a history of allergy to aceclofenac. He was treated with an antihistamine (clemastine) and a parenteral corticosteroid (hydrocortisone). After symptomatic improvement, he was discharged with oral corticosteroids. Quincke's disease is a rare form of isolated angioedema of the uvula in which it is often not possible to discern a cause. Previous intake of unusual drugs should increase the level of suspicion for a pharmacological allergic etiology. Symptoms such as oropharyngeal foreign body sensation and dysphagia should not be underestimated, and patients should be quickly evaluated by the Otorhinolaryngologist.