Discussions By Condition: I cannot get a diagnosis.

Urticaria- need help with this one...

Posted In: I cannot get a diagnosis. 1 Replies
  • Posted By: Anonymous
  • January 4, 2009
  • 06:12 PM

50 year old male patient, drinker, smoker 1pack/2day, works as a beekeper, presents with urticaria (nodules type) around the skin of the head, neck and thigh. Says that has got these symptoms for over 3 months. The rash only appears in the morning, and retracts after. Blood culture, biochemistry, all is normal. No pruritus or fever associated with.
On the stool exam, giardia came out, however, after 7 days of metronidazole, no improvement. The other morning, his left eye got swollen, like Tyson's after 12 rounds. :eek:
What other exams can he perform? Immunogram? Any other ideas? anything is welcomed...:confused:

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  • Well the eye problem is most certainly due to angioedema, which very commonly accompanies urticaria. The urticaria is also the consequence of the Giardia Lamblia infection. Although you don't make mention, I'm presuming that you're a healthcare professional and that the person described in the posting is your patient. As you well know, urticaria can arise from a number of causes, including viral invasion or use of NSAIDs early in the course, even idiopathic in nature. In this case, however, the Giardia is to blame. Bile drainage and duodenal smear will likely produce evidence of both ova and parasites and you'll want to perform panels for determination on immunoglobulin M,G,A and E. You don't mention treatment of the urticaria itself, but realize that standard antihistamine treatment is typically ineffective in such cases. Allergy immunotherapy with Giardia's antigen preparation associated to treatment will likely produce the desired therapeutic effect. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 4, 2009
    • 07:36 PM
    • 0
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