CASE REPORT   

The Journal of Sports Medicine and Physical Fitness 2019 November;59(11):1934-6

DOI: 10.23736/S0022-4707.19.09176-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

A challenging diagnosis of exercise-related transient abdominal pain

Julie CASTAGNA ¹ ✉, Anne JEAND’HEUR ¹, Franck GRILLET ², Florence CASTELAIN ¹, Pauline ROUX ³, François AUBIN ¹, Philippe MANZONI ², Fabien PELLETIER ¹

¹ Department of Dermatology and Allergy, Besançon University Hospital, Besançon, France; ² Department of Imaging, Besançon University Hospital, Besançon, France; ³ Department of Pneumology and Respiratory Explorations, Besançon University Hospital, Besançon, France

A 17-year-old woman, high-performance triathlete, presented transient abdominal pain, face angioedema and sometimes syncope during exercise. Exercise-induced anaphylaxis was suspected at first. Allergic explorations with skin prick tests were negative but wheat flour specific IgE and recombinant rTri a14 (LTP) were weakly positive. However, wheat eviction did not improve the symptoms and stress test after wheat oral challenge did not show any signs of anaphylaxis. An abdominal ultrasound revealed peak expiratory velocities with a stenosis evaluated at 70 to 80 percent with turbulences in the celiac artery, confirmed by computed tomography angiogram. The diagnosis of exercise-induced median arcuate ligament syndrome (MALS) was retained and we discuss here the challenging diagnosis mimicking exercise-induced anaphylaxis.

KEY WORDS: Median arcuate ligament syndrome; Angioedema; Anaphylaxis; Abdominal pain