5yr old girl, edema develop every night since 10 days involve only face . no pain no itching.history of taking syp 'liver o xyme' since 2 year that is discontinued before 15 days.most of swelling is reduced after injectable antihistaminic and steroids than started orally..is there need of further investigation?

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There might be dental abscess mostly maxillary tooth. Advice OPG. Augmentin 125 suspension, 5 ml TID for 5 days if found abscess due to dental caries. Swelling might be increasing during night because there will be no muscle movement to apply pressure and drain the abscess. This might be a reason. I am not sure. I have seen patients with this kind of symptoms.

But there is no pain and relieve by cetrizine
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Agree with @Dr. Chandrasekhar Lakkoju sir opinion I also want to add another d/d.. Angioedema It presents with swelling of facial deep layers and lips with raised temp of that area.. The etiology could be varied From food allergens, medications, any other systemic disorders and heriditary It can lead to serious airway compromise if it obstructs the tongue or throat Angioedema responds well to corticosteriods and anti histaminics.. The trigger factors should be identified and precautions should be taken regarding exposure to allergens..

In which infection we will get nocturnal edema? And abscess without pain ?
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Infection or Allergy. Differentiate & act fast. Situations may aggravate & turn serious.

Agree sir. It is an emergency for sure.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Dental root abscess with cellulitis. Amoxicillin clavunanic acid 457 mg syrup 3.5ml bd Serratio peptidase and ibuprofen may be added

100 percent agree
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ALLERGIC. Reaction. ..to. Medication.... Disturbed. Renal. Function... INVESTIGATIONS... 1. Blood. Exam .... CBC.......LFT......LFT.......T3....T4 ...... TSH....... Electrolytes...... Proteins .. 2. COMPLETE. Urine. Exam.....M/E...

It's looks like a clear cut case of Angiooedema. Detailed history may give the clue for allergen responsible for it

May be Dental abscess, worms, filariasis, mumps, serumcretanine?

Why only at night sir?.
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Angioneurotic oedema

Why only at night Modi sir ?
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On first visit with the above history, I would suspect it to be either Periapical abscess or Allergy. Abscess because the swelling/cellulitis is more pronounced on cheek than lips. The features going against abscess are painless, relieves of its own. Then Allergy but the cause must be ascertained. I would not term it Angioedema because of the same fact that lips are less swollen than cheek. And now as you state that swelling is reduced with anti allergics and steroids. So, the diagnosis could be termed as Allegic Reaction. The million Dollar question still remains unanswered “ The cause of Allergy” unless we are sure of it we would not be able to guide a patient to avoid a certain allergen and we cannot put a child on long term steroids or anti allergics for unknown Allergen.

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