Pediatric Hereditary Angioedema as a Cause of Acute Compartment Syndrome of the Hand and Forearm: A Case Report

Abstract

Background: Compartment syndrome of the upper extremity is a surgical emergency that, when left untreated, can have dire consequences. Its causes are numerous, one of which is the uncommon entity hereditary angioedema, an autosomal dominant disease resulting in edema in a variety of potential locations, including the extremities. This is only the second time hereditary angioedema has been mentioned in the literature as a cause of compartment syndrome. Methods: We present a case of hereditary angioedema leading to hand and forearm compartment syndrome in a 13-year-old pediatric patient. Diagnosis of hereditary angioedema was made by our Rheumatology colleagues with physical exam and a thorough history, and confirmed by laboratory studies. Results: Our patient presented with compartment syndrome of the hand and forearm and underwent hand and volar forearm fasciotomies. She was subsequently worked up for hereditary angioedema with laboratory results confirming the diagnosis. She was discharged after a 5-day hospitalization with prophylactic C1-inhibitor therapy. Conclusions: Hereditary angioedema is a rare but known cause of compartment syndrome of the upper extremity, and must be considered when patients present with compartment syndrome of unknown etiology. This disease can be diagnosed by laboratory studies and symptoms can be controlled with medical therapy.

Acute quadruple extremity compartment syndrome due to angio-oedema after polypharmacy overdose including olmesartan medoxomil, telmisartan and vildagliptin

“…Non-traumatic aetiologies, accounting for <10% of ACS cases, include complications such as haemorrhagic events, inflammatory reactions following soft tissue infections, deep vein thrombosis and rhabdomyolysis 14–16. The transition from HAE to ACS is notably rare, with a paucity of cases, specifically three paediatric instances, reported in the literature 17–19…”

Acute Compartment Syndrome of the Hand in a 14-Month-Old Child: A Case Report

“…The etiologies of ACS in children are numerous (Table 1); however, they could vary significantly based on the age group [5][6][7]. In general, trauma or surgical positioning are the usual causes in children above 14 years of age.…”

“…Besides trauma, the etiologies of ACS are diverse. These could include animal bites, hemorrhages, or in rare cases, hereditary angiomas, as reported in some case reports [5][6][7].…”