Management dilemma: managing bipolar affective disorder in a patient with hereditary angioedema

Hereditary angioedema (HAE) is a rare autosomal dominant disorder caused by the deficiency or dysfunction of C1 esterase inhibitors. We present a case of a female in her 50s with HAE and bipolar affective disorder (BPAD). She has experienced severe depressive and manic episodes with significant disruption to her life. She has also had potentially life-threatening episodes of recurrent angioedema with severe facial and body swelling and post-pharyngeal symptoms.She presented to us with a depressive episode with suicidal ideation. Her angioedema was flared by both psychological stressors and psychotropic medications. Choosing the correct mood stabiliser without triggering angioedema was a major challenge in her treatment. Also, psychosocial interventions and frequent liaison with her immunology team were necessary to provide her with optimum care in the community. Here, we discuss the challenges we faced and how we overcame them in managing this rare presentation of coexisting BPAD and HAE.