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Mistaken Diagnosis of Angioedema

44-year-old white male, without any significant past medical history, presented with swelling of the tongue, dyspnea and chest tightness for two days.  On initial presentation, his physical examination revealed apparent swelling of his tongue.  A diagnosis of angioedema with possible laryngeal edema was considered, and the patient was placed on mechanical ventilation with racemic epinephrine, and IV methylprednisolone. Workup for hereditary angioedema was negative.  He improved and was discharged.  The patient re-presented two weeks later with the same symptoms and slurred speech.  On physical examination, the tongue was mildly swollen and was deviated to the left side, suggestive of left hypoglossal nerve palsy. The remainder of his examination including the cranial nerves, motor and sensory functions were all normal.

This case is based on the article published in JGIM in January 2009.