Abstract
Wasp stings are commonly encountered in tropical countries. Various manifestations after bee sting have been described. We report 66-years old healthy female developed lower limb ischemia, myocardial infarction, renal, liver and hematological involvement following multiple bee stings. She was fully recovered after two weeks of treatment.
Highlights
Wasp string can cause local and systemic allergic reactions [1]
We report a case with multiple organ dysfunctions and ischemia in lower limb following wasp sting which, to the best of our knowledge, would be the first reported case published for lower limb ischemia following wasp sting in Srilanka.This is a second case reported regarding wasp sting in northern province; it indicates about one million people in Jaffna peninsula is in a risk of stinging and its effects [4]
A 66-year old previously healthy female farmer had been stung with a swarm of wasps on her entire body while worked in the paddy field at around 10 o’clock in the morning. She developed severe pain at the site of stings and swelling of the body within minutes. She was admitted about 40 minutes after bee sting with itching, urticarial rash, headache and vomiting to district hospital Thellipalai where she developed severe ischemic type of chest pain, reduced urine out put and left lower limb pain and discoloration about 36 hours after wasp sting and she was transferred to teaching hospital, Jaffna
Summary
Wasp string can cause local and systemic allergic reactions [1]. Local reactions are common.But more serious complications like intravascular hemolysis, rhabdomyolysis, thrombocytopenia, acute renal failure, liver impairment and myocardial infarction are less common [1,2,3]. She had left lower limb ischemia as evidenced by gangrene of toes and duplex scan revealed left femoral, popliteal and posterior tibial arteries colour flow were seen with normal velocity but left dosalis pedis arery colour flow was seen but low velocity She was managed with IV Hydrocortisone 100mg 6hourly for 3days oral prednisolone 10mg tds for 4dys, IV Chlorpheniramine 10mg stat oral Chlorpheniramine 4mg bd for 7days, iv co-amoxyclav 0.6mg tds (Does reduced due to renal impairment) with IV cloxacillin 500mg 6 hourly for 10days, Paracetamol 1g tds for 5 days sos and subcutaneous Enoxaparin 40mg bd for 7 days with aspirin 150mg noct, clopidogrel 75mg noct and atrovastatin 20mg noct. During the review in two weeks, she was perfectly well with normal blood investigation and healing wound
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