Uvular Edema

On the second day of hospitalization for recurrent acute pancreatitis of unknown cause, a 32-year-old man awoke with difficulty in swallowing, throat discomfort, and a swelling in the back of his mouth. He had no history of similar oral symptoms.

Since the onset of pancreatitis about 3 days earlier, the patient had been vomiting repeatedly. He also had difficulty in sleeping and felt that he had been snoring more than usual. He had no stridor, wheezing, or gagging.

Examination revealed a markedly swollen, pendulous uvula. The patient was afebrile and not in acute respiratory distress. His voice was slightly hoarse. The airway was patent; the edema was strictly confined to a midline, nonerythematous uvula. The uvula had no discharge or exudate. The tonsils, peritonsillar region, soft palate, and tongue were normal.

The cause of this isolated uvular edema was unclear, although irritation related to recurrent emesis was a possibility. Another consideration was Quincke disease-isolated uvula angioedema caused by a type I hypersensitivity reaction-although this is rare and typically recurrent.¹ Less likely possibilities included hereditary angioedema caused by C1 esterase inhibitor deficiency, which can result in recurrent episodes of angioedema and can be demonstrated by low C4 levels²; infection or uvulitis, particularly in a febrile patient with a uvula that appears to be inflamed; and concurrent epiglottitis.^3,4 Other considerations, such as inhalation injury, postendotracheal intubation injury, adverse medication effect, and marijuana use, were not applicable to this patient.^1,5,6

Corticosteroid therapy to decrease inflammation and discomfort was considered but was deferred because the swelling slowly subsided. The patient was discharged 2 days later after the pancreatitis resolved but was ultimately lost to follow-up.

References:

REFERENCES:

1.

Huang CJ. Isolated uvular angioedema in a teenage boy.

Internet J Emerg Med

. 2007;3(2).

2.

Markovic SN, Inwards DJ, Phyliky RP. Acquired C1 esterase inhibitor deficiency.

Ann Intern Med

. 2000;133:839.

3.

McNamara R, Koobatian T. Simultaneous uvulitis and epiglottitis in adults.

Am J Emerg Med

. 1997;15:161-163.

4.

Cohen M, Chhetri DK, Head C. Isolated uvulitis.

Ear Nose Throat J

. 2007;86:462, 464.

5.

Evans TC, Roberge RJ. Quincke's disease of the uvula.

Am J Emerg Med

. 1987;5:211-216.

6.

Guarisco JL, Cheney ML, LeJeune FE Jr, Reed HT. Isolated uvulitis secondary to marijuana use.

Laryngoscope

. 1988;98:1309-1312.