Case history
Case history #1
A healthy 30-year-old woman presents to emergency room triage half an hour after direct contact of her right foot with some fire ants at a birthday party. She describes experiencing swelling in her right foot and an itchy raised rash on her legs, belly, back, and neck within minutes of the exposure. She reports that this had happened to her before, so she immediately took a dose of diphenhydramine. She says she decided to go to the emergency room because she felt like her tongue was swelling and she was becoming breathless. On exam her vital signs are blood pressure 121/85 mmHg, heart rate 132 beats per minute, respiratory rate 26, and O2 saturation level 99%. Skin exam shows diffuse, raised, red erythematous rash. Exam of head, eyes, ears, nose, and throat shows minimal tongue swelling but no stridor or drooling. Lung exam reveals rapid respirations with good air movement but trace wheezes. Cardiac exam shows tachycardia but no murmurs and equal distal pulses. Abdominal exam shows a soft, nontender abdomen with active bowel sounds. The patient displays an anxious and alert sensorium. The neurologic exam is otherwise without deficits.
Case history #2
A 9-year-old boy is brought to the emergency room after being stung by a bee at a picnic. He is crying hysterically. After 15 minutes of calming him down, exam reveals a swollen tender upper lip but no tongue swelling, no drooling, no stridor, no rash, and no other complaints.
Other presentations
Patients may not always know they have been bitten or stung. Many present to medical practitioners looking for diagnosis and treatment of rashes, pustules, swelling, or concern for skin infections. Some patients may be asymptomatic but are concerned about the possibility of transmission of diseases from bites or stings. Some reactions may develop hours to days after the original insult. Black widow spider bites may present with abdominal cramping mimicking an acute surgical abdomen. Rarely, progressive local tissue necrosis may occur subsequent to a recluse spider bite.
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