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A Very Big Hand Is a Very Big Problem: Soft-Tissue Infection, Venous Thrombosis, or Just an Insect Sting?

Authors
  • Damanti, Sarah1
  • Brignolo-Ottolini, Barbara1
  • Mansi, Marta1
  • Marcucci, Maura2, 3
  • Mari, Daniela2, 3
  • Pravettoni, Valerio4
  • 1 School of Specialization in Geriatrics and Gerontology, Università degli Studi di Milano, Milan, Italy
  • 2 Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  • 3 Department of Clinical Sciences & Community Health, University of Milan, Milan, Italy
  • 4 Allergology and Immunology Unit, Fondazione IRCCS Ca’ Granda, Osp. Maggiore Policlinico, Milan, Italy
Type
Published Article
Journal
European Journal of Case Reports in Internal Medicine
Publisher
SMC Media Srl
Publication Date
Jan 20, 2016
Volume
3
Issue
2
Identifiers
DOI: 10.12890/2016_000312
PMID: 30755855
PMCID: PMC6346946
Source
PubMed Central
Keywords
License
Unknown

Abstract

A 67-year-old woman developed severe edema of her right hand and forearm, for which she was treated with antibiotics, without benefit. The echography excluded a venous thrombosis. Subsequently, she referred a wasp sting before the development of the edema. Specific Hymenoptera venom immunoglobulin E (IgE) was found to be positive for paper wasp and yellow jacket. A large local reaction (LLR) was diagnosed due to the hymenoptera sting. Self-injectable epinephrine was prescribed for possible, though unlikely, systemic reactions following hymenoptera stings. LEARNING POINTS The differential diagnosis of an upper forearm and hand oedema may be challenging. In order to reach the correct diagnosis and to prescribe proper treatment, careful examination and history taking is essential. All possible causes should be taken into proper consideration. Large local reaction (LLR) is characterized by hot, flushed and thick edema after a hymenoptera sting. As the risk of a systemic reaction, upon the first sting following a consistent index LLR, it is important to recognize an LLR in order to prescribe self-injectable epinephrine to prevent the occurrence of anaphylaxis.

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