A 61-year-old man in Turkey died following an anaphylactic shock and vascular blockage after being stung by an insect in three places, according to a case study published in BMC Cardiovascular Disorders.
In Plain English: The Clinical Takeaway
The patient, who had diabetes, hypertension, obesity, and was a smoker, had a coronary stent placed about 10 years prior. He had no known history of insect sting allergies. Following the stings on April 29, he developed anaphylactic shock. CT imaging confirmed that the large artery in the abdomen and the arteries branching into the pelvis were blocked.
Although surgeons removed the blood clots, blood flow was not sufficiently restored. The medical team constructed a bypass using a synthetic vascular graft. While the procedure restored warmth to the legs, myocardial injury was identified. Clinicians placed a stent in the severely narrowed coronary artery. However, the patient suffered from muscle and kidney damage and shock, and died on the morning of May 1 following cardiac arrest.
Kounis Syndrome and Ischemia-Reperfusion Injury
Attending physicians determined that the patient’s cardiac symptoms aligned with Kounis syndrome, a condition wherein allergic reactions trigger the narrowing or blockage of coronary arteries. Inflammatory substances released during an allergic reaction can cause blood vessels to constrict and promote the formation of blood clots. This mechanism, combined with the patient’s existing vascular disease, may have led to the blockage of the large vessels supplying the legs.
The clinical picture was further complicated by reperfusion injury. As blood flow was restored, substances from the damaged tissue spread through the body, placing stress on the kidneys and heart. The medical team explained that the patient’s death was likely influenced by shock from heart damage, as well as systemic damage following the blockage and reperfusion of blood flow to the legs. Despite the surgical restoration of blood flow, the muscle damage already sustained did not disappear.
| Date | Clinical Event | Medical Intervention |
|---|---|---|
| April 29 | Stung in three places; onset of anaphylactic shock | Emergency stabilization and hospital transfer |
| April 29 (Post-transfer) | Acute ischemia in lower extremities; arterial thrombosis | Thrombectomy and synthetic graft bypass |
| April 30 | Myocardial injury identified | Coronary stenting procedure |
| May 1, Early Morning | Cardiac arrest | Death |
Contraindications & When to Consult a Doctor
To prevent insect stings, it is recommended to avoid perfumes and wear clothing that covers the skin. If a single insect is nearby, do not swat it away. If attacked by multiple insects, retreat indoors immediately. If stung, move to a safe place. If a stinger remains, remove it quickly by sliding it sideways with a fingernail or the edge of a card. Wash the area with soap and water and apply a cold compress wrapped in cloth. If stung in multiple places or in the mouth or throat, seek medical attention as soon as possible. If breathing is difficult, or if there is tongue or throat swelling or severe dizziness, call 119 immediately. If a prescribed epinephrine auto-injector is available, use it immediately. Patients in serious condition should not walk and should be kept lying down, though the upper body may be slowly raised if breathing is difficult.
Preventative Protocols Highlighted in BMC Cardiovascular Disorders
The medical team emphasized that severe allergic reactions to insect stings should not be viewed solely as a problem affecting the coronary arteries. If the legs become cold and painful or a pulse cannot be detected, a blockage of a large vessel should be promptly checked. This case was recently published in the international journal BMC Cardiovascular Disorders.
References
- Case Report. BMC Cardiovascular Disorders.
