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

• Published in: Medicine (Baltimore) 2021-01, Vol.100 (4), p.e24492-e24492
• Main Authors: Ou, Wei-Fan, Huang, Wei-Hsuan, Chiu, Hsien-Fu, Mao, Yan-Chiao, Wen, Mei-Chin, Chen, Cheng-Hsu, Hung, Sheng-Jou, Wu, Ming-Ju, Wu, Chieh-Liang, Chao, Wen-Cheng
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Adrenal Cortex Hormones - therapeutic use; Adult; Animals; Clinical Case Report; Female; Humans; Insect Bites and Stings - complications; Insect Bites and Stings - immunology; Insect Bites and Stings - therapy; Male; Middle Aged; Plasmapheresis; Respiratory Distress Syndrome - etiology; Rhabdomyolysis - etiology; Treatment Outcome; Wasp Venoms - adverse effects; Wasp Venoms - immunology; Wasps
• ISSN: 0025-7974; 1536-5964
• 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.