Ant sting-induced whole-body pustules in an inebriated male: A case report

Abstract

Background: Many ant species can harm humans; however, only a few cause life-threatening allergic reactions. Normally, reactions caused by ants occur in patients who come into contact with ant venom. Venom contains various biologically active peptides and protein components, of which acids and alkaloids tend to cause anaphylaxis. Ant venom can cause both immediate and delayed reactions. The main histopathological changes observed in ant hypersensitivity are eosinophil recruitment and Th2 cytokine production.

Case summary: A 70-year-old man was bitten by a large number of ants when he was in a drunken stupor and was hospitalized at a local hospital. Five days later, because of severe symptoms, the patient was transferred to our hospital for treatment. Numerous pustules were observed interspersed throughout the body, with itching and pain reported. He had experienced fever, vomiting, hematochezia, mania, soliloquy, sleep disturbances, and elevated levels of myocardial enzymes since the onset of illness. The patient had a history of hypertension for more than 1 year, and his blood pressure was within the normal range after hypotensive drug treatment. He had no other relevant medical history. Based on the clinical history of an ant bite and its clinical manifestations, the patient was diagnosed with an ant venom allergy. The patient was treated with 60 mg methylprednisolone for 2 d, 40 mg methylprednisolone for 3 d, and 20 mg methylprednisolone for 2 d. Oral antihistamines and diazepam were administered for 12 d and 8 d, respectively. Cold compresses were used to treat the swelling during the process. After 12 d of treatment, most pustules became crusts, whereas some had faded away. No symptoms of pain, itching, or psychological disturbances were reported during the follow-up visits within 6 mo.

Conclusion: This case report emphasizes the dangers of ant stings.

Keywords: Anaphylaxis; Ant sting; Ant venom allergy; Case report; Delayed reaction; Psychological disturbances; Sterile pustule.

Figure 1

The anthill and ants. A: A large anthill of imported fire ants are nesting on a green belt; B: Several soldier ants and worker ants are working.

Figure 2

The clinical features of the patient. A: Diffuse pustules in the trunk; B: Diffuse pustules in the lower limb; C: Crust on the trunk; D: Crust on the lower limb.

Figure 3

Pathological examination. A: A pustule was seen in stratum spinosum. B: The infiltration of eosinophils were seen in dermis (hematoxylin-eosin).