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Severe anaphylactic reaction to mediterranean jellyfish (Ropilhema nomadica) envenomation: Case report.

ABSTRACT: We present a 15-year-old female patient with an anaphylactic reaction to a jellyfish sting, sustained while surfing in the Mediterranean Sea. She experienced immediate difficulty in breathing, hoarseness and itching and was taken by ambulance to the emergency department, receiving intramuscular adrenaline on the way. She presented with periorbital swelling and facial edema and improved with systemic steroids and antihistamines. She was discharged 2 days later with allergy service follow up at our institution. This is the first case report documenting anaphylaxis due to Mediterranean jellyfish envenomation.

SUBMITTER: Friedel N

PROVIDER: S-EPMC5615929 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Severe anaphylactic reaction to mediterranean jellyfish (<i>Ropilhema nomadica</i>) envenomation: Case report.

Friedel Nadav N Scolnik Dennis D Adir Dikla D Glatstein Miguel M

Toxicology reports 20160315

We present a 15-year-old female patient with an anaphylactic reaction to a jellyfish sting, sustained while surfing in the Mediterranean Sea. She experienced immediate difficulty in breathing, hoarseness and itching and was taken by ambulance to the emergency department, receiving intramuscular adrenaline on the way. She presented with periorbital swelling and facial edema and improved with systemic steroids and antihistamines. She was discharged 2 days later with allergy service follow up at ou ...[more]

PMID: 28959564

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Project description:BackgroundHemodialysis-associated anaphylactic reactions are rare and frequently complex in nature due to the sheer number of possible culprit agents. Unfortunately, dialysis is often unavoidable or strictly essential for life-saving solute clearance or fluid removal in patients with end stage kidney failure and those with severe acute kidney injury. It is of utmost importance that the culprit agent is identified and avoided to allow continuation of dialysis treatment as needed.Case presentationWe present 2 cases of hemodialysis-associated anaphylactic reactions. These patients developed anaphylactic reactions peri-dialysis and were initially suspected to have dialyser reactions. They were investigated in a controlled healthcare setting and possible culprit agents were systemically identified and eliminated. They both underwent allergy testing and were diagnosed with chlorhexidine allergy. Of note, Case 1 was an incident dialysis patient at the time of presentation and Case 2 was a prevalent dialysis patient. This suggests that the time from initial sensitization to reaction may not always be helpful in determining if a particular agent is the culprit of an anaphylactic reaction. In both cases, the patients were dialysed through a tunnelled dialysis catheter. We postulate that the presence of an exit site, which represents a compromise to the integrity of the skin's epidermal barrier, may have a significant role in the development of these reactions. As chlorhexidine is a widely used disinfectant in hemodialysis, it is imperative that we consider it as a possible culprit agent when these reactions arise. To our knowledge, there are no other reported cases of anaphylaxis secondary to chlorhexidine use in dialysis patients other than a previous report in 2017. Our report also highlights the possibility of these reactions occurring more frequently in patients with damaged epidermal barriers and in patients exposed to higher environmental concentrations of chlorhexidine. These are novel concepts that can be explored with further research.ConclusionChlorhexidine associated anaphylactic reactions can occur in the peri-dialysis setting and a high index of suspicion is paramount to diagnosis.

Project description:BackgroundAbacavir is a nucleoside reverse transcriptase inhibitor that is used as a component of the antiretroviral treatment regimen in the management of the human immunodeficiency virus for both adults and children. It is efficacious, but its use may be limited by a hypersensitivity reaction linked with the HLA-B*57:01 genotype. HLA-B*57:01 has been reported to be rare in African populations. Because of the nature of its presentation, abacavir hypersensitivity is prone to late diagnosis and treatment, especially in settings where HLA-B*57:01 genotyping is not routinely done.Case reportWe report a case of a severe hypersensitivity reaction in a 44-year-old Kenyan female living with the human immunodeficiency virus and on abacavir-containing antiretroviral therapy. The patient presented to the hospital after recurrent treatment for a throat infection with complaints of fever, headache, throat ache, vomiting, and a generalized rash. Laboratory results evidenced raised aminotransferases, for which she was advised to stop the antiretrovirals that she had recently been started on. The regimen consisted of abacavir, lamivudine, and dolutegravir. She responded well to treatment but was readmitted a day after discharge with vomiting, severe abdominal pains, diarrhea, and hypotension. Her symptoms disappeared upon admission, but she was readmitted again a few hours after discharge in a hysterical state with burning chest pain and chills. Suspecting abacavir hypersensitivity, upon interrogation she reported that she had taken the abacavir-containing antiretrovirals shortly before she was taken ill. A sample for HLA-B*57:01 was taken and tested positive. Her antiretroviral regimen was substituted to tenofovir, lamivudine, and dolutegravir, and on subsequent follow-up she has been well.ConclusionsClinicians should always be cognizant of this adverse reaction whenever they initiate an abacavir-containing therapy. We would recommend that studies be done in our setting to verify the prevalence of HLA-B*57:01.

Dataset Information

Severe anaphylactic reaction to mediterranean jellyfish (Ropilhema nomadica) envenomation: Case report.

Publications

Severe anaphylactic reaction to mediterranean jellyfish (<i>Ropilhema nomadica</i>) envenomation: Case report.

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