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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Redness, Swelling, Tightness, Intermittent Pain In Feet And Palms. Taking Enalapril For Hypertension. Your Input?

i have been experiencing redness, swelling , tightness and pain intermitently to both feet and palms of my hands. I have had 6 episiodes of lip swelling. none of the symptoms are relieved with antihystermines. it is painful to walk, the skin is tight and hot to touch. I am 34, i take enalapril for hypertension which is well controlled, and thyroxine for hypothyroidism which is also controlled. I am an emergency nurse and have shown these symptoms to many doctors over the years and none can diagnose what is causing it, recent fbc, lft, tft, u&e results were normal ???? your input would be appreciated thank you
Wed, 14 Nov 2012
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General & Family Physician,  's  Response
hi,

thank you for your query and welcome to hcm community.



i am not sure what is causing the hand, feet and lip swelling . Any family history of this problem ? Any colicky abdominal pain ? Any breathing difficulty ? Is it episodic and self limiting over several days & not responding to Antihistamine, Steroid ?



Assuming this edema is non-pitting and excluding the heart, liver, kidney and thyroid causes, the thing that comes up in my mind is "Hereditary Angioedema" though all the clinical features dont match with it.



The cutaneous swelling is usually full, tight and non-itchy & dont respond to Antihistamines/Steroid. It can be aggravated by medication like ACE inhibitor or ARB.



I would suggest you lab investigations C1 inhibitor level and C4 level just for the interest.



Hope, this helps. If you do the investigations then don't forget to inform me the result as i have curiosity of this rare genetic disorder.
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Redness, Swelling, Tightness, Intermittent Pain In Feet And Palms. Taking Enalapril For Hypertension. Your Input?

hi, thank you for your query and welcome to hcm community. i am not sure what is causing the hand, feet and lip swelling . Any family history of this problem ? Any colicky abdominal pain ? Any breathing difficulty ? Is it episodic and self limiting over several days & not responding to Antihistamine, Steroid ? Assuming this edema is non-pitting and excluding the heart, liver, kidney and thyroid causes, the thing that comes up in my mind is Hereditary Angioedema though all the clinical features dont match with it. The cutaneous swelling is usually full, tight and non-itchy & dont respond to Antihistamines/Steroid. It can be aggravated by medication like ACE inhibitor or ARB. I would suggest you lab investigations C1 inhibitor level and C4 level just for the interest. Hope, this helps. If you do the investigations then don t forget to inform me the result as i have curiosity of this rare genetic disorder.