Dataset Information

Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis: Two case reports.

ABSTRACT:

Introduction

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.

Patient concerns

Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis).

Diagnosis

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.

Interventions

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.

Outcomes

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.

Conclusion

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.

SUBMITTER: Ou WF

PROVIDER: S-EPMC7850695 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis: Two case reports.

Ou Wei-Fan WF Huang Wei-Hsuan WH Chiu Hsien-Fu HF Mao Yan-Chiao YC Wen Mei-Chin MC Chen Cheng-Hsu CH Hung Sheng-Jou SJ Wu Ming-Ju MJ Wu Chieh-Liang CL Chao Wen-Cheng WC

Medicine 20210101 4

<h4>Introduction</h4>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.<h4>Patient concerns</h4>Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis).<h4>Diagnosis</h4>Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic in ...[more]

PMID: 33530269

Similar Datasets

Project description:BackgroundVitamin K inhibitors (e.g. warfarin) and indirect thrombin inhibitors (e.g. heparin) are widely used to prevent thromboembolic disorders (e.g. myocardial infarction, venous thromboembolism, and stroke). These agents have been mainstays of anticoagulation for people older than 60 years. However, their administration is associated with a risk of bleeding and requires careful monitoring of patients. Novel oral anticoagulants (NOACs), such as dabigatran, are significantly safer in preventing thromboembolism than warfarin and heparin (sporadically causes thrombocytopenia) and are more specific for their target protein, thrombin. The major advantage of dabigatran, a direct thrombin inhibitor, is that it reversibly inhibits both free and clot-bound thrombin by tight binding affinity and the predictable pharmacodynamic effect. A few studies, however, reported that dabigatran can cause thrombocytopenia, although the underlying mechanism remains unclear. Thus, an antidote for dabigatran was developed to prevent thrombocytopenia.Case presentationIn this report, we discuss two cases of thrombocytopenia and purpura after dabigatran treatment. A 73-year-old man showed hemorrhagic necrotic skin lesions on his neck and right hand. He was administered dabigatran (220 mg/day) for cerebral infarction for three days and his platelet count decreased abruptly (6000/μL). This suggested that dabigatran had caused thrombocytopenia and purpura; therefore, dabigatran administration was discontinued. The results of a blood test, performed 14 days after stopping dabigatran treatment, showed that the platelet count had recovered to the normal range of more than 150,000/μL. A 75-year-old woman had taken warfarin continuously for 8 years. However, she had a new cerebral infarction. Therefore, warfarin treatment was replaced with dabigatran (300 mg/day). Her platelet count decreased (41,000/μL) significantly and dabigatran treatment was discontinued. The blood test results show that platelet counts gradually recovered to the normal range.ConclusionsDabigatran application may cause bleeding; therefore, careful monitoring during dabigatran treatment is required to prevent thrombocytopenia. An explanation is that the interaction of dabigatran with thrombin, because of its strong binding affinity, may cause the observed thrombocytopenia.

Dataset Information

Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis: Two case reports.

Introduction

Patient concerns

Diagnosis

Interventions

Outcomes

Conclusion

Publications

Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis: Two case reports.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets