ZEYNEP BURÇİN GÖNEN, Fatma DOĞRUEL, CANAY YILMAZ ASAN, LEYLAGÜL KAYNAR, Mustafa ÇETİN

Herediter anjioödemde kısa dönem danazol profilaksisi ile implant tedavisi: Vaka raporu

Herediter anjio ödem (HAÖ), C1 esteraz inhibitör proteininin konjenital eksikliğine bağlı olarak meydana gelen, nadir gözlenen, otozomal dominant bir hastalıktır. HAÖ atakları, spontan veya bir travmaya bağlı olarak, ekstremitelerde, yüzde, göğüste, hava yolunda veya karın bölgesinde şişlikler şeklinde meydana gelebilir. Dental işlemlerden önce, profilaksi amacıyla , androjenler, taze dondurulmuş plazma, C1 esteraz inhibitör protein konsantreleri ve antifibrinolitikler kullanılmaktadır. Bu vaka raporunda, danazol profilaksisi ile implant tedavisi uygulanan, herediter anjioödemli bir hasta sunulmaktadır. Preoperatif 3 gün 100 mg ve operasyon günü 200 mg danazol profilaksisi ile hastanın sol üst molar bölgesine bir adet dental implant (Straumann Roxolid Implants) yerleştirilmiş ve post operatif 2 gün 100 mg danazol tedavisine devam edilmiştir. Hastada implant tedavisine bağlı olarak, akut veya post operatif herhangi bir atak görülmemiştir. Sonuç olarak, rekürrent anjio ödem hikayesi olan hastalar, dental implant cerrahisinden önce, C1 esteraz inhibitör protein eksikliği yönünden, dikkatle değerlendirilmelidir.

Anahtar Kelimeler:

: herediter anjio ödem, danazol

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1. Frank MM. Herditaryangioedema: a halfcentury of progress. J Allergy Clin Immunol 2004;114:626-8.
2. Fabiani JE, Paulin P, Simkin G, Leoni J, Palombarani S, Squiquera L. Hereditaryangioedema: therapeuticeffect of danazol on C4 and C1 esteraseinhibitors. AnnAllergy 1990; 64:388-2.
3. Witschi A, Krahenbühl L, Frei E, Saltzman J, Spath PJ, Müller UR. Colorectalintussusception: An unusualgastrointestinalcomplication of hereditaryangioedema. IntArchAllergyImmunol 1996;111:96-8.
4. Bowen T, Cicardi M, Farkas H, BorkK,Longhurst HJ, Zuraw B, et al. 2010 International consensus algorithm for the diagnosis, therapyandmanagement of hereditaryangioedema. Allergy AsthmaClinImmunol 2010;6(1): 24.
5. Bork K, Meng G, Staubach P, Hardt J. Treatment with C1 inhibitor concentrate in abdominal pain attacks of patients with hereditary angioedema. Transfusion 2005; 80: 1774-84.
6. Visentin DE, Yang WH, Karsh J. C1-esterase inhibitor transfusions in patients with hereditary angioedema. Ann Allergy Asthma Immunol 1998; 80: 457-61.
7.Agostoni A, Aygören-Pürsün E, BinkleyKE,Blanch A, Bork K, Bouillet L, et al. Hereditary and acquired angioedema: problemsandprogress: proceedings of thethird C1 esterase inhibitor deficiency workshop and beyond. J AllergyClinImmunol 2004;114(3 Suppl): 51-131.
8. Bork K, Barnstedt SE. Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema. J AmDentAssoc 2003;134(8): 1088-94. 9. Zuraw BL. Hereditaryangioedema. N EnglJMed 2008;359(10):1027-36.
10. Maeda S, Miyawaki T, Nomura S, Yagi T, Shimada M. Management of oral surgery in patientswithhereditaryoracquiredangioedemas: reviewandcasereport. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2003;96(5): 540-3.
11. Papadopoulou-Alataki E. Upperairwayconsiderations in hereditaryangioedema. CurrOpinAllergyClinImmunol 2010;10(1):20- 5.
12. Banerji A, Sloane DE, Sheffer AL. Heredi- taryangioedema: a currentstateof-the-art review, V: attenuatedandrogensforthetreatment of hereditaryangioedema. Ann Al- lergyAsthmaImmunol 2008;100(1 Suppl 2):19-22.
13. Gelfand JA, Sherins RJ, Alling DW, Frank MM. Treatment of hereditaryangioedemawithdanazol. Reversal of clinicalandbiochemicalabnormalities. N Engl J Med 1976;295(26): 1444-8.
14. Pitts JS, Donaldson VH, Forristal J, Wyatt RJ. Remissionsinduced in hereditaryangioneu- roticedemawith an attenuatedandrogen (danazol): correlation between concentrations of C1-inhibitor andtheforthandsecond com - ponents of complement. J LabClinMed 1978; 92(4):501-7.
15. Agostoni A, Cicardi M, Martignoni GC, Berga- maschini L, Marasini B. Danazolandstanozolol in long-termprophylactictreatment of hereditaryangioedema. J AllergyClinIm - munol 1980;65(1):75-9.
16. Warin AP, Greaves MW, Gatecliff M, Williamson DM, Warin RP. Treatment of hereditaryangio-oedemabylowdose at- tenuatedandrogens: disassociation of clin- icalresponsefromlevels of C1 esteraseinhibitorand C4. Br J Dermatol 1980;103(4):405-9.
17. Gompels MM, Lock RJ, Abinun M, Bethune CA, Davies G, Grattan C, et al. C1 inhibitor deficiency: consensus document. Clin Exp Immunol 2005;139(3):379-94.
18. Bork K, Bygum A, Hardt J. Benefitsandrisks of danazol in hereditaryangioedema: a long-termsurvey of 118 patients. Ann Al- lergyAsthmaImmunol 2008; 100(2): 153- 61.