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Anaphylaxis and delayed hymenoptera in a child with fire ant envenomation

Published:January 23, 2013DOI:https://doi.org/10.1016/j.ajem.2012.09.022
      The red imported fire ant is a species of Hymenoptera native to South America, which has spread throughout much of the United States. Hymenoptera envenomations can cause severe allergic reactions and anaphylaxis as well as severe toxin-mediated systemic reactions including rhabdomyolysis, renal failure, liver injury, and coagulopathy. However, red imported fire ant envenomations have rarely been reported to cause these systemic toxin-mediated effects. Here we present the first reported pediatric case of a 2-year-old male infant who presented with both anaphylaxis and evolving signs of systemic envenomation, including rhabdomyolysis and renal failure, as a result of multiple fire ant stings. The case illustrates the potential for a significant hymenoptera toxidrome in the setting of multiple stings and emphasizes the importance of close follow-up given the potential for slowly evolving findings.
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