Loria R C, Wedner H J
Washington University School of Medicine, Department of Medicine, St. Louis, MO 63110.
Ann Allergy. 1989 Apr;62(4):289-93.
A patient with asthma presented with a history of recurrent episodes of facial swelling. The swelling occurred in the preauricular area and extended to the angle of the jaw. The patient attributed these episodes to a "food allergy" as they occurred during or immediately following meals. The only medication the patient was using was inhaled epinephrine (Primatene MistR), two puffs, ten to twenty times a day. Subsequent evaluation revealed that the patient had sarcoidosis. Differential diagnosis of the facial swelling included food-related angioedema, sarcoid parotitis, or catecholamine-induced sialadenosis, which is a rare complication associated with excessive catecholamine administration. A gallium-67 citrate scan demonstrated abnormal pulmonary and hilar uptake of the radiotracer, but not lacrimal or parotid gland uptake, strongly arguing against sarcoidosis as the cause of the facial swelling. Episodes of swelling completely abated when the patient stopped using the epinephrine inhalers. At 5 months of follow-up she has had two recurrent episodes of facial swelling, each time associated with the use of inhaled epinephrine. Thus this patient's facial swelling most likely represents catecholamine-induced sialadenosis. This adverse drug reaction, associated with excessive use of inhaled catecholamines must be kept in mind in patients who abuse inhaled beta-adrenergic agonists and report parotid swelling.
一名哮喘患者有反复面部肿胀发作史。肿胀出现在耳前区域，并延伸至下颌角。患者将这些发作归因于“食物过敏”，因为它们发生在进餐期间或之后不久。患者正在使用的唯一药物是吸入用肾上腺素（普米克令舒），每天十到二十次，每次两喷。后续评估显示该患者患有结节病。面部肿胀的鉴别诊断包括食物相关的血管性水肿、结节性腮腺炎或儿茶酚胺诱导的涎腺肿大，后者是与过量给予儿茶酚胺相关的一种罕见并发症。枸橼酸镓-67扫描显示放射性示踪剂在肺部和肺门有异常摄取，但泪腺或腮腺无摄取，强烈提示结节病不是面部肿胀的原因。当患者停止使用肾上腺素吸入器时，肿胀发作完全缓解。在随访的5个月中，她有两次面部肿胀复发，每次都与使用吸入用肾上腺素有关。因此，该患者的面部肿胀很可能代表儿茶酚胺诱导的涎腺肿大。在滥用吸入型β-肾上腺素能激动剂并报告腮腺肿胀的患者中，必须牢记这种与过量使用吸入型儿茶酚胺相关的药物不良反应。
