Hereditært angioødem i odontologien
Baggrund – Hereditært angioødem er en sjælden arvelig lidelse, der kan forårsage potentielt livstruende hævelser i larynx efter odontologisk behandling. Der gennemgås her en sygehistorie, som belyser behovet og mulighederne for profylaktisk behandling forud for tandbehandling. Patienttilfælde – En 47-årig kvinde blev behandlet med danazol to gange forud for tandbehandling. Hun udviklede den ene gang efterfølgende angioødem, der initialt blev behandlet med højdosis tranexamsyre uden effekt. Ødemet persisterede, og patienten søgte behandling på skadestuen, hvor hun blev behandlet sent i forløbet og med insufficiente doser af komplement C1-inhibitor koncentrat. Tilstanden remitterede spontant efter få dage. Udviklingen af angioødem kunne formentlig være undgået ved korrekt profylakse med komplement C1-inhibitor koncentrat forud for tandbehandling. Konklusion – Profylaktisk behandling af patienter med HAE beror på et individuelt grundlag, der tager højde for sygdomsaktivitet, tidligere behandlingstiltag og effekten heraf.
Klinisk relevans:
Hereditary angioedema in odontology
Background – Hereditary angioedema (HAE) is a rare inherited disease that can cause potentially lethal oedema of the larynx after dental treatment. We present a case that illustrates the needs and possibilities for prophylaxis before dental treatment. Case study – A 47 year old woman with HAE was twice treated with danazol before dental work. On one occasion she developed orofacial angioedema which initially was treated with tranexamic acid which did not resolve the oedema. The attack persisted and the patient sought help at the emergency room, where she was administered complement C1-inhibitor replacement therapy in insufficient doses. The angioedema resolved spontaneously after few days. The patient might not have had experienced any swelling if she had received the correct prophylaxis with complement C1-inhibitor replacement therapy before dental treatment. Conclusion – Prophylactic treatment should be based on individual assessment and take into consideration the dental history, efficacy of former treatment regimens and activity of the disease.
