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Hereditary angioedema (HAE) is characterized by recurrent angioedema attacks with no urticaria. This disease has a high mortality due to asphyxia. Level of complement component 4 (C4), C1 esterase inhibitor (C1-INH) level and function, and genetic mutations determine different endotypes of HAE. Clinical presentation and the triggers of vasogenic edema may change according to the endotypes. An adolescent girl with oligomenorrhea, obesity, hirsutism, and acanthosis nigricans was diagnosed with polycystic ovary syndrome and prescribed ethinyl estradiol and cyproterone acetate containing oral contraceptive (OC). On the sixteenth day of treatment, she developed angioedema of the face, neck, and chest leading to dyspnea. Adrenaline, antihistamine, and corticosteroid treatments were ineffective. In the family history, the patient’s mother and two cousins had a history of angioedema. C1-INH concentrate was administered with a diagnosis of HAE. C4 and C1-INH level and activity were normal. Genetic analysis identified a mutation in the factor 12 (F12) gene, and the diagnosis of F12-related HAE was made. OC treatment was discontinued. She has had no additional angioedema attacks in the follow-up period of two years. OC containing estrogen may induce the life-threatening first attack of F12-related HAE even in children. Recurring angioedema attacks in the family should be asked before prescribing estrogen-containing OC pills. [ABSTRACT FROM AUTHOR]

Objective: Ventilator-associated pneumonia (VAP) is the second most common form of hospital-acquired infection. Prediction of possible etiologic agents and initiation of appropriate and narrow-spectrum antibiotherapy is crucial to reduce morbidity and mortality. Clinical and radiologic variable analyses may help clinicians to foresee the usual cause of VAP. Methods: This was a retrospective observational study evaluating the clinico-radiologic characteristics of VAP in a pediatric intensive care unit (PICU) of a tertiary referral university hospital between January 2011 and December 2016. Results: A total of 1,323 patients in the PICU were followed during the study period, wherein 78 with a median age of 10 months (1-188) were detected to have VAP. Patients were divided into two groups according to the etiologic agents as gram-positive (n=16, 20.5%) and gram-negative VAP (n=62, 79.5%). Radiologic findings included peribronchial thickening (n=32, 41.0%), diffuse interlobular septal thickening (n=38, 48.7%), patchy infiltrate (n=54, 69.2%), consolidation (n=54, 69.2%), and pleural effusion (n=21, 26.9%). The presence of consolidation and pleural effusion were significantly more common among the patients with gram-positive VAP (p-values are 0.004 and 0.02). Conclusion: Clinical and radiologic evaluation of patients may be a clue for the estimation of the microbiology of VAP, which is highly recommended before the initiation of empirical antibiotherapy. [ABSTRACT FROM AUTHOR]

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