25 year-old woman with episodic abdominal pain, lip and hand swelling, urticaria, and all normal labs except for a low C1 esterase inhibitor
We have a 25 yo woman with 10 yr hx of episodic abdominal pain, lip and hand swelling and urticaria. Only significant lab result was C1 esterase inhibitor low 33 (<67) and on repeat 27. C4, CH50, C1Q, CU index, Tryptase, cryoglobulins, antithyroid abs, ESR, ANA, lyme, Serotonin, Chromogranin A, Immunofixation, H. Pylori, O&P, all negative. RAST and skin tests to foods and enviromental all neg. IgE 24. She had a weak reaction to corn and wheat on skin test & has avoided. Has been off gluten for year. An abdominal CT was negative (no abdominal complaint at time). She was recently diagnosed with postural orthostatic tachycardia syndrome and started on Toprol. More recently she has had migraines and had a tonic clonic seizure while waiting in a hair salon. We have witnessed her feet turn blue when dangling them on exam table, and apparently her hands will as well. Another MD is contemplating starting a low dose anti depressant for anxiety as she is afraid to leave her home. Would you order any other tests and what are your thoughts on starting a preventative c1 esterase inhibitor?