Department of Internal Medicine.
Division of Nephrology, Department of Internal Medicine.
Medicine (Baltimore). 2021 Jan 29;100(4):e24492. doi: 10.1097/MD.0000000000024492.
Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings.
Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis).
Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings.
Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17.
Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2.
In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.
多次蜂蜇伤是一种全身性反应毒素导致的紧急情况，临床表现多样，我们报告了两例具有明显临床和转录组学特征的患者。
两名无系统性疾病的患者在被一群大黄蜂（Vespa basalis）袭击后出现了近 90 个疼痛性丘疹。
患者 1 为 44 岁健康男性，临床表现主要为溶血、肝损伤、横纹肌溶解和急性肾损伤。患者 2 为 49 岁健康女性，除了与患者 1 相同的临床表现外，还出现严重急性呼吸窘迫综合征（ARDS）。我们使用核糖核酸测序（RNA-Seq）来描述 2 例临床表现不同的患者在多次蜂蜇伤后的炎症反应。
两名患者均接受了 5 次血浆置换治疗，患者 1 进一步接受了机械通气 8 天，并接受了 8 次血液透析，直到第 17 天。
两名患者经过上述治疗均恢复良好。我们使用 RNA-Seq 显示患者 1 中存在以中性粒细胞为主的受调节免疫反应。在患者 2 中，我们发现第 1 周存在强烈的中性粒细胞反应，第 2 周存在强烈的中性粒细胞和促炎反应。此外，我们发现第 2 周与肾脏系统过程相关的信号表达增加。
总之，我们报告了两例在被同一群大黄蜂袭击后表现出共同和独特表现的患者。两名患者均有溶血、横纹肌溶解、肝损伤和急性肾损伤，其中 1 例有 ARDS。全转录组分析与不同的临床表现一致，这些结果表明 RNA-Seq 有可能在多个蜂蜇伤患者中分离复杂的炎症反应。两例患者均给予血浆置换和皮质类固醇治疗，病例 2 还接受了 8 次血液透析。
