Nag Shankha Subhra, Ghosh Nilanjan, Singh Arvind Kumar, Nayek Kaustav, Mitra Piyali
Paediatr Int Child Health. 2015 May;35(2):157-9. doi: 10.1179/2046905514Y.0000000131. Epub 2014 Jul 7.
Most hypersensitivity reactions to insect stings are immediate, ranging from transient local reactions of little medical consequence to fatal anaphylaxis. Rarely, some patients have delayed reactions after a period of apparent normality which manifest as systemic features which can be life-threatening. A 3-year-old boy was attacked by a swarm of bees, estimated to be about 200 in number. There was an immediate cutaneous reaction which was treated at a local hospital. After 9 days, he presented with oliguria, dark-coloured urine, pedal oedema, hypertension and acute kidney injury (AKI). He was managed conservatively with fluid restriction, control of blood pressure and peritoneal dialysis, and renal function returned to normal gradually over the following 9 days. The delayed-onset AKI and other laboratory abnormalities suggested a immune-mediated type III hypersensitivity reaction leading to renal insufficiency. After improvement of initial hypersensitivity reactions, patients with bee stings should be followed up in order to detect any late-onset complications which might be life-threatening.
大多数对昆虫叮咬的超敏反应是即时性的，从几乎没有医学后果的短暂局部反应到致命的过敏反应。很少有患者在一段明显正常的时期后出现延迟反应，表现为可能危及生命的全身症状。一名3岁男孩遭到一群估计约200只蜜蜂的攻击。当时出现了即时性皮肤反应，并在当地医院接受了治疗。9天后，他出现少尿、深色尿液、足部水肿、高血压和急性肾损伤（AKI）。对他采取了保守治疗，包括限制液体摄入、控制血压和腹膜透析，在接下来的9天里肾功能逐渐恢复正常。延迟发作的急性肾损伤和其他实验室异常表明是免疫介导的III型超敏反应导致肾功能不全。在初始超敏反应改善后，应对蜂蜇伤患者进行随访，以便发现任何可能危及生命的迟发性并发症。
