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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 patient's symptoms of progressive lip swelling without urticaria, rash, or itching also align with HAE.

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 documentation, or there could be a delayed reaction.
  • Drug-Induced Angioedema (e.g., NSAIDs): The patient's history of a similar reaction to ibuprofen as a child and his father's similar reactions suggest a possible sensitivity to NSAIDs, which could be contributing to the current episode.
  • Idiopathic Angioedema: This diagnosis is considered when angioedema occurs without an identifiable cause, which could be the case if no specific trigger is found.

Do Not Miss Diagnoses

  • Anaphylaxis: Although the patient denies difficulty breathing or swallowing and shortness of breath, anaphylaxis can present with isolated angioedema and rapidly progress to a life-threatening condition. It's crucial to monitor the patient closely for any signs of respiratory compromise.
  • Airway Obstruction: Any condition causing significant swelling in the mouth and throat area poses a risk of airway obstruction, which is a medical emergency.

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.
  • Angioedema due to Complement System Abnormalities: Abnormalities in the complement system can lead to angioedema, but these are rare and typically associated with other systemic symptoms or conditions.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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