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[dshears]

My 25 year old daughter has had this problem occur twice now. The first time, several years ago, while visitng in Italy, after swimming in questionnable water and now recently, while living in Key West, Florida.
Problem: She got a sudden and dramatic swelling around her face, especially under the eyes, around the jaw and cheek area. Then, she cannot feel her face where swollen, almost as if novacane had been administered.
When pressed by fingertips, she feels fluid.
While at the hospital for an emergency visit today, she noticed that the backs of her arms looked like cellulite, although she has little or no fat (120lbs.) with blotches of red and white appearing like cottage cheese. This abated after a couple of hours.
Upon arriving at home and laying down, she noticed what appeared to be welts on her legs that looked raised but were not and in fact her skin was smooth to the touch.
The worst facial swelling was around her jaw, as though her wisdom teeth had been removed and her face was huge.
Additionally, she gets a pain in the middle of her back, along the spine, making it incredibly painful for her to lay down.
She starts all of this with simple flu-like symptoms/fever.
In Italy, the Doctors could not figure out what was wrong.
They couldn't in Key West either, stating they think she's had an allergic reaction to something, unrelated to the flu bug.
Several x-rays revealed nothing except a slight sinus infection in the cavity under her eye.
They've given her benadryl and prescribed anti-biotics.
About two months ago she had a cold/sinus infection that wouldn't go away so she took anti-biotics then too, which apparently, we think resolved that problem.....or did it?
Can you give any guidance that I could relay to her?
Dennis

[dshears]

Thanks, again Smokeater.
Her regular Doctor today indicated that he felt very strongly that the reaction was caused by some crunchy peanut butter she had, earlier in the day of the problem.
I think we'll go with that for now and keep our fingers crossed.
Dennis

[dshears]

Thank you Dr. Tomasello and thank you Smokeater.

[smokeater]

It still mat be an allergic reaction you know.  I had an almost identical incident about a month ago where I had taken over the counter cough medicine.  Dymatapp of all things.  (go figure).  Anyhow, my husband first called the poison control center after we noticed the same symptoms as you discribe in your daughter, hige cellulite looking wels, pretty much all over my body, red and white splothes, lasting several hours, which benedryl, did not apease at all, actually almost seemed to make worse.  I went to a local ER and they also gave severl IV medications which did not seem to work and they too were stumped as I seemed to keep getting worse with each additional shot or stay the same.  But eventually they realized that I was allergic to the sudaphedrine in the medications they were giving to me to stop the reaction, which apparently was the medication that started the reaction in the first place.  Alll I am saying is that it still might be an allergic reaction, my friends daughter did the same thing everytime she got into a carseat in a hot car.  She was allergic to her own sweat.  Never heard of anything like that before, but she would swell so bad.  I may be way off track but there are many possiblities.  Im sure the doctor will help you with his reply as well.  Good Luck!

[smokeater]

Your very welcome.  I was almost positive it was an allergic reaction when I heard your daughters symptoms.  Please let us know if/when you have a final diagnosis.  I would be interested in knowing if we were on target or not.  I just know that when I had mine it was very itchy and painful.  It hurt to wear clothes or anything at times.  I hope she does well.  Please keep us informed as we are concerned and my family will be prying for her.  Good luck once again and God Bless to all.

[Forum-M.D.-DT]

Thanks for visiting the family practice forum.
You describe several symptoms
1. Swelling around the face
2. Numbness of the face
3. Red and while "blotches" on the backs of her arms
4. back pain

I have to concur that she is most likely having an allergic reaction to something. The question is what? We know the symptoms are more likely to occur after she is in the water. I practice in a community surrounded by several lakes. In the summer I see "swimmer's itch" quite a bit however with this there is usually not such a widespread rash/swelling, rather more discrete papules. (Swimmer's itch common to freshwater)
Another condition comes to mind, that being something called "Clam Digger's Itch". This is caused by a "schistosome" (parasite) and is found very commonly in SALTWATER.(common areas include Atlantic, Pacific, Gulf and Hawaiian coasts. It is also common near Cape cod. The lesions associated with "swimmer's itch" and "Clam Digger's Itch" may be associated with a febrile-like illness (sort of like a mild flu) which lasts 5-7 days.
Antihistamines are the treatment of choice for the aforementioned conditions. I will use benadryl or a prescription antihistamine Zyrtec until the rash resolves.
Antibiotics would not improve these conditions.
If she came to my office, I would likely refer her to an allergist for allergy testing. Make certain to mention when these "allergies" appear to present (i.e. when swimming in saltwater). That may help the allergist determine which allergens she would be tested for.
Also, I would encourage a patient with the history you describe to take and antihistamine like Zyrtec daily if she is going to be swimming in saltwater.

I hope this helps!
Dean M. Tomasello, M.D.