An unexpected challenging airway: Urticaria factitia caused difficult mask ventilation and tracheal intubation

A 42-year-old male patient [weight: 98 kg and height: 178 cm (body mass index = 30)] presented to the neurosurgery clinic with left back and shoulder pain. Subsequently, an emergent tracheostomy was performed by an otolaryngologist because face mask ventilation and several trials of endotracheal intubation were unsuccessful and laryngeal mask airway was inadequate owing to oropharyngeal mucosal edema. Intradermal and dermal prick tests for midazolam, propofol, remifentanil, and rocuronium performed by the immunology department did not detect any reaction. [...]the patient was diagnosed as having UF with DPU.