Differential Diagnosis for Progressive Lip Swelling
Single Most Likely Diagnosis
- Hereditary Angioedema (HAE): Given the patient's history of similar reactions to ibuprofen, a family history of angioedema with ibuprofen, and a previous diagnosis of ACE-inhibitor induced angioedema, HAE is a strong consideration. The lack of urticaria, rash, or itching also points towards HAE, as these are not typical features of this condition.
Other Likely Diagnoses
- ACE-Inhibitor Induced Angioedema: Although the patient's lisinopril was discontinued after a previous episode, it's possible that another ACE inhibitor was started without being documented, or there could be a residual effect, though this is less likely given the timeframe.
- Drug-Induced Angioedema (e.g., NSAIDs): The patient's history of a similar reaction to ibuprofen as a child and the current episode could be related to another drug exposure, especially considering the family history of reactions to NSAIDs.
- Idiopathic Angioedema: This diagnosis is considered when angioedema occurs without an identifiable cause, which could be the case here if no specific drug exposure is found and other causes are ruled out.
Do Not Miss Diagnoses
- Anaphylaxis: Although the patient denies difficulty breathing, swallowing, or symptoms of anaphylaxis like urticaria or rash, anaphylaxis can present atypically, and it is crucial to consider this diagnosis due to its potential severity and the need for immediate treatment.
- Airway Compromise: Any condition causing significant swelling in the mouth and throat area poses a risk of airway compromise, which is a medical emergency. Continuous monitoring of the patient's airway is essential.
Rare Diagnoses
- Acquired Angioedema: This condition is associated with lymphoproliferative disorders, autoimmune diseases, or the use of certain drugs. It's less likely given the patient's lack of significant medical history but should be considered if other causes are ruled out.
- Allergic Contact Angioedema: This would involve exposure to an allergen that causes a localized allergic reaction leading to angioedema. It's less likely given the description but could be considered if the patient has been exposed to new substances or products.