Pediatric Non-Hereditary, Non-Allergic, Bradykinin-Mediated Angioedema in a Postoperative Intensive Care Patient: A Case Report

Non-allergic, bradykinin-mediated angioedema is a life-threatening emergency well described in adult medical literature. To date, there remains a paucity of literature as the diagnosis relates to pediatric populations.1 In contrast to the more commonly encountered mast-cell-mediated angioedema, bradykinin-mediated angioedema is slower in onset and does not classically respond to treatments that generally resolve anaphylaxis.2 We report a rare case of severe postoperative non-allergic, bradykinin-mediated angioedema in a 14-year-old child. After development of severe airway edema, the patient was emergently nasotracheally intubated by an otolaryngologist in the operating room and remained refractory to aggressive treatments in the intensive care unit for several days. Angioedema resolved one week later after administration of tranexamic acid (TXA). Tranexamic acid is used off-label for management of bradykinin-mediated angioedema and is recommended by various organizations for use in adults but is not found in common pediatric treatment algorithms.3-6 Emergency medicine and critical care providers must remain vigilant in their assessment of the pediatric airway to recognize angioedema and treat it aggressively targeting both allergic and non-allergic causes in the undifferentiated presentation. Though bradykinin-induced angioedema is less commonly encountered in pediatrics, TXA is a low risk, potentially highly effective treatment which should be considered in severe cases of refractory undifferentiated angioedema in children.7.