A young man presented with a swollen uvula (which he called a "swollen dingle dangle") after smoking marijuana for the first time the night before. Uvular edema, also known as Quinke's edema, can be caused by conditions like hereditary angioedema, allergic reactions, infections, medications/drugs like NSAIDs and ACE inhibitors, trauma, and smoking. While cannabis is a listed cause, it is likely due to thermal injury from the high burning temperature rather than genuine allergy in this case. Treatment would depend on the suspected cause but may include antibiotics for infection or anaphylaxis medication for allergic reaction.

1. A young man arrives complaining that he can’t swallow normally,
and feels that he has a ‘swollen dingle dangle’ in his throat.
You examine him, and indeed find that he DOES have a swollen
dingle dangle…although you call it his uvula.
He doesn’t have any past medical history, has never had this happen
before, but wonder whether ‘smoking dope’ might be a cause? He
had tried marijuana for the first time the night before.
• Do you know the eponymous name for this sign?
• What causes do you know? Is it possible it was Marijuana
related?
• What are his treatment options ?

3. It is called Uvular edema, or eponymously named Quinkes edema.
There are many causes…but one of the most cited is Hereditary angioedema related
to C1 esterase deficiency, in which case it is often recurrent and can run in the
family. It can be a manifestation of Type 1 hypersensitivity reaction, although in that
case there are often other manifestations of allergy like skin rash, facial swelling,
wheeze etc.
Other listed causes include idiopathic (commonest cause), trauma (eg, post
intubation), infections (group B streptococci, Haemophilus influenzae type B,),
medications and drugs (NSAIDS, ACE inhibitors, ipratropium bromide), and
snoring (I’ve seen in in sometime after a big night out!).
Cannabis IS listed as a cause, and it may be in some cases that there is a genuine
allergy to the agent…but it is probably more often due to thermal injury. Cannabis
burns at a much higher temperature than tobacco, which is why it is often inhaled
through a cooling bath (bong/hubbly bubbly pipe etc).
On this occasion management was expectant, but treatment would obviously depend
a bit on what you thought the cause was….and might include the standard
anaphylaxis agents if you thought it was due to Type 1 allergy, or antibiotics if you
thought it was an infection.