Differential Diagnosis for Facial Swelling in a 17-Year-Old Boy
Single Most Likely Diagnosis
- Hereditary Angioedema (HAE): This condition is characterized by recurrent episodes of severe swelling, often triggered by stress, trauma, or medical procedures. The patient's history of a similar episode after a tooth extraction and the absence of other symptoms such as fever or rash support this diagnosis. The family history of hypertension is also notable, as HAE can be associated with other conditions.
Other Likely Diagnoses
- Allergic Reaction: Although the patient does not report any recent exposure to common allergens, an allergic reaction could still be a possible cause of the facial swelling. The presence of mild edema on the hands also suggests a systemic reaction.
- Acute Allergic Contact Dermatitis: This condition could cause facial swelling, especially if the patient came into contact with a strong allergen. However, the lack of a reported rash or exposure history makes this less likely.
Do Not Miss Diagnoses
- Anaphylaxis: Although the patient does not exhibit all the typical symptoms of anaphylaxis (e.g., stridor, muffled voice, or hypotension), this condition can be life-threatening and requires immediate attention. The presence of severe facial swelling and mild edema on the hands warrants consideration of anaphylaxis.
- Infectious Causes (e.g., Cellulitis, Abscess): Although the patient does not have a fever or other signs of infection, it is essential to consider infectious causes, especially if the swelling is localized or if there are other symptoms such as pain or redness.
Rare Diagnoses
- Mastocytosis: This condition is characterized by an accumulation of mast cells in various tissues, leading to episodes of swelling, flushing, and other symptoms. Although rare, mastocytosis could be a consideration in this patient, especially if other diagnoses are ruled out.
- Systemic Capillary Leak Syndrome: This rare condition is characterized by recurrent episodes of swelling, often triggered by stress or other factors. Although it is a rare diagnosis, it could be considered if other causes are excluded.