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Erythema nodosum following a jellyfish sting.

At least 100 of the approximately 9,000 species of coelenterates are dangerous to humans. The most common syndrome following an envenomation is an immediate intense dermatitis, with characteristic skin discoloration, local pain, and systemic symptoms. In this case report, we describe a case of erythema nodosum with articular manifestations following envenomation with an unknown jellyfish. Serological testing of the victim revealed marked elevation of immunoglobulins G and M directed against Physalia physalis, the Portuguese man-of-war. The patient's condition did not respond to conventional topical therapy for coelenterate envenomation, but was successfully managed with systemic corticosteroid therapy. This case demonstrates that the emergency physician should consider a delayed reaction to a marine envenomation in any victim who presents with an acute dermatological disease following immersion in marine coastal waters.

Animals↗
PubMed2006

Hymenoptera sting-induced Kounis syndrome: effects of aspirin and beta-blocker administration.

Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with activation of interacting inflammatory cells including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It is caused via inflammatory mediators released during inflammatory cell activation. A variety of conditions, drugs, and environmental exposures can induce Kounis syndrome. A patient suffering from coronary artery disease and taking metoprolol and aspirin was stung by wasps and developed cutaneous allergic signs including rash, urticaria and orbital oedema. This was followed by retrosternal pain, chest discomfort and electrocardiographic changes compatible with acute myocardial ischemia. Cardiac enzymes, troponins and blood pressure remained normal but serum tryptase was raised. The clinical implications and pathophysiology of this rare association are discussed.

Adrenergic beta-Antagonists↗
PubMed2006

Favorable hymenoptera sting reactions during childhood may have enabled transmission of responsible allergic genotype into generations.

Allergic reactions caused by hymenoptera venoms represent a major medical problem for certain groups of population. In addition to different anaphylaxis reactions, less frequent fatal cases have been recorded in Europe and USA. It has been observed that generally, following the initial anaphylaxis reaction to the venom of such insects, milder and less frequent successive reactions occur in children than in adults, though the latter are less frequently stung. Such findings could be explained by the fact that mainly children may have the advantage of self-restraining the aggravation of further reactions due to the ability of a higher plasticity of immune and non-immune protective mechanisms or the ability of adjustment of regulatory autonomous vital systems, activated after a prior allergic reaction. Hypothetically such ability has enabled most of those individuals to reach at least major age and frequently have their successors. This way the genetic lines carrying the respective allergic phenotype might have been transmitted generation after generation, although the prior allergic generations lacked modern treatment of anaphylactic reactions.

Animals↗
PubMed2006

Stings of edible jellyfish (Rhopilema hispidum, Rhopilema esculentum and Nemopilema nomurai) in Japanese waters.

Three edible jellyfish Rhopilema hispidum, R. esculentum and Nemopilema nomurai are virulent to humans. We monitored one patient that was stung sequentially by these three species of jellyfish. The first species caused a persistent eruption, the second produced significant pruritus and the last induced only cutaneous symptoms rather than severe systemic disorders reported for its Chinese counterpart. The lesions of these jellyfish species are characteristic and common in workers harvesting medusae. There is no significant incidence of symptoms by ingesting these animals.

Animals↗