Persistent Facial Swelling in an 8-Year-Old

An 8-year-old previously healthy girl presented with acute swelling and scaling of the right side of the face overlying the mandible. She had a 2-year history of intermittent bilateral facial swelling, with prior episodes resolving without treatment in 4-6 weeks. These episodes had not responded to topical corticosteroid or antifungal therapy. On examination, the patient was afebrile with age-appropriate vital signs. She had firm, nontender facial edema extending from the right oral commissure to the cheek, with overlying red-purple scaling plaques (Figure).

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