Acute compartment syndrome of the hand after a wasp sting: a case report

Abstract

Compartment syndrome of the hand is an uncommon entity in children and is usually the result of trauma or burns. Insects, such as wasps, produce a wide variety of toxins such as amines, peptides, and enzymes that can cause local and systemic inflammatory reactions after a sting. This inflammation can, in rare cases, lead to the development of a compartment syndrome. We present the case of a 5-year-old boy who developed a compartment syndrome of the hand after a single wasp sting that required emergent fasciotomy. To our knowledge, this has not been reported previously in the literature. An institutional review board approved review of the case. The clinical presentation, laboratory studies, radiographs, and possible-exacerbating factors leading to the development of a compartment syndrome, as well as the surgical procedure and postoperative course, were reviewed. Preoperative, intraoperative, and postoperative photographs are also presented. A 5-year-old boy presented to the emergency department 18 h after a single wasp sting to the dorsum of his hand. Based on his history and physical examination, hand compartment pressures were measured in his hand and found to be elevated. He underwent emergent fasciotomies with delayed wound closure. The patient healed uneventfully and at 5-month follow-up had full use of his hand, full range of motion, and normal 2-point discrimination in all the fingers. In conclusion, while wasp and other insect stings are common in children, this case is the first, to our knowledge, of a compartment syndrome of the hand after a wasp sting. Local measures used to treat insect stings such as heat and elevation may have played a role in the development of a compartment syndrome. It is important to have a high index of suspicion for this condition in a patient who presents with signs and symptoms of a compartment syndrome after an insect sting. IV.