Villada Gabriel, Hafeez Farhaan, Ollague Jose, Nousari Carlos H, Elgart George W
Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida.
J Cutan Pathol. 2017 Dec;44(12):1012-1017. doi: 10.1111/cup.13036. Epub 2017 Sep 21.
Skin reactions to the sting of the imported fire ant have characteristic clinicopathological features.
One case of experimental envenomation was prospectively followed during 48 hours, with biopsies. In addition, 6 cases from our laboratory were retrospectively evaluated histopathologically for the following features: spongiosis, exocytosis (and type of cells), pustule formation, erosion/ulceration, epidermal necrosis, scale/crust, papillary dermal edema, inflammatory dermal infiltrate (cell type, density, depth, distribution, shape), red blood cell extravasation, vasculopathy and vasculitis.
The typical lesion follows a very distinctive clinical and histopathologic evolution over 48 hours, with the formation of a subepidermal pustule overlying a wedge-shaped area of dermal collagen basophilic degeneration with scattered neutrophils. In the 6 cases retrieved from our files, the main features were a superficial and deep dermal, perivascular, periadnexal and interstitial infiltrate consisting of neutrophils, with basophilic degeneration of the collagen. A subepidermal pustule was noted in half of the cases.
In biopsies taken in a clinical setting, even in the absence of the characteristic subepidermal pustule, the diagnosis of imported fire ant sting can be suspected if there is a superficial and deep perivascular, periadnexal and interstitial infiltrate composed of neutrophils, with some basophilic denaturation of collagen.
对入侵红火蚁叮咬的皮肤反应具有特征性的临床病理特征。
对1例实验性毒液注射病例进行了48小时的前瞻性跟踪，并进行了活检。此外，对我们实验室的6例病例进行了回顾性组织病理学评估，观察以下特征：海绵形成、细胞外渗（及细胞类型）、脓疱形成、糜烂/溃疡、表皮坏死、鳞屑/痂皮、乳头真皮水肿、炎症性真皮浸润（细胞类型、密度、深度、分布、形态）、红细胞外渗、血管病变和血管炎。
典型病变在48小时内呈现出非常独特的临床和组织病理学演变，在真皮胶原嗜碱性变性的楔形区域上方形成表皮下脓疱，伴有散在的中性粒细胞。在从我们档案中检索出的6例病例中，主要特征是真皮浅层和深层、血管周围、附件周围和间质浸润，由中性粒细胞组成，伴有胶原嗜碱性变性。半数病例可见表皮下脓疱。
在临床环境中进行活检时，即使没有特征性的表皮下脓疱，如果存在由中性粒细胞组成的浅层和深层血管周围、附件周围和间质浸润，且伴有一些胶原嗜碱性变性，也可怀疑为入侵红火蚁叮咬。
