Hand-foot Syndrome in a Patient with Multiple Fire Ant Stings
Hand-foot Syndrome in a Patient with Multiple Fire Ant Stings
The case is reported of an elderly patient with known previous exposure to fire ant stings, and who presented with hand-foot syndrome (HFS) in the setting of multiple fire ant stings to the lower extremities. Both hands and both feet were red, swollen, and mildly tender. Treatment was with fluocinonide cream, and all symptoms resolved as the classic fire ant skin lesions regressed. HFS was initially reported in association with acute crisis in sickle cell anemia and thalassemia and more recently as a common toxicity of chemotherapy administration. This is the first report of its occurrence in the setting of fire ant envenomization. Although recent literature may indicate a potential therapeutic benefit from COX-2 antagonists, the process appears to be self-limited, and requires only conservative treatment.
Imported fire ant infestation has been an increasing problem in the Southeast United States for the last seventy years. Three species are extant in this area, the most common being Solenopsis invicta, and all of which share in common an aggressive nature and tendency to inject venom when disturbed. The skin lesions associated with these stings are well described. While the sting characteristically results in the formation of sterile pustules, complications due to infection can occur and are probably more common in patients with diabetes or other forms of immune suppression or debilitation. Other reactions include anaphylaxis in patients with hypersensitivity, and less commonly reported neurologic complications including seizures. While most commonly occurring in the outdoors, multiple fire ant bites have been increasingly reported in long-term care facilities. These are more likely to be multiple bites with higher complication rates. Herein is reported the case of an elderly male patient who presented with multiple fire ant bites and an associated hand-foot syndrome which cleared as the reaction to the bites subsided.
The case is reported of an elderly patient with known previous exposure to fire ant stings, and who presented with hand-foot syndrome (HFS) in the setting of multiple fire ant stings to the lower extremities. Both hands and both feet were red, swollen, and mildly tender. Treatment was with fluocinonide cream, and all symptoms resolved as the classic fire ant skin lesions regressed. HFS was initially reported in association with acute crisis in sickle cell anemia and thalassemia and more recently as a common toxicity of chemotherapy administration. This is the first report of its occurrence in the setting of fire ant envenomization. Although recent literature may indicate a potential therapeutic benefit from COX-2 antagonists, the process appears to be self-limited, and requires only conservative treatment.
Imported fire ant infestation has been an increasing problem in the Southeast United States for the last seventy years. Three species are extant in this area, the most common being Solenopsis invicta, and all of which share in common an aggressive nature and tendency to inject venom when disturbed. The skin lesions associated with these stings are well described. While the sting characteristically results in the formation of sterile pustules, complications due to infection can occur and are probably more common in patients with diabetes or other forms of immune suppression or debilitation. Other reactions include anaphylaxis in patients with hypersensitivity, and less commonly reported neurologic complications including seizures. While most commonly occurring in the outdoors, multiple fire ant bites have been increasingly reported in long-term care facilities. These are more likely to be multiple bites with higher complication rates. Herein is reported the case of an elderly male patient who presented with multiple fire ant bites and an associated hand-foot syndrome which cleared as the reaction to the bites subsided.
Source...