A problematic pout

Finding the cause of this cyclical swelling

This teenage girl faces grossly swollen lips every month like clockwork, with each episode getting progressively worse.

Lips

The 16-year-old has been experiencing angio-oedema-like swelling and ulceration of the bottom and top lip for nine months, beginning just prior to menstruation and lasting several days to a week.

In addition, she experiences dysmenorrhoea and menorrhagia, as well as fatigue and myalgia.

Swabs for HSV 1 and 2 are negative. During an episode of swelling, a punch biopsy of her lips is taken, showing mild parakeratosis and acanthosis with a

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