Case Report
Hand-foot Syndrome in a Patient with Multiple Fire Ant Stings
Abstract
The case is reported of an elderly patient with known previous exposure to fire ant stings, and who presented with hand-foot syndrome (HFS) in the setting of multiple fire ant stings to the lower extremities. Both hands and both feet were red, swollen, and mildly tender. Treatment was with fluocinonide cream, and all symptoms resolved as the classic fire ant skin lesions regressed. HFS was initially reported in association with acute crisis in sickle cell anemia and thalassemia and more recently as a common toxicity of chemotherapy administration. This is the first report of its occurrence in the setting of fire ant envenomization. Although recent literature may indicate a potential therapeutic benefit from COX-2 antagonists, the process appears to be self-limited, and requires only conservative treatment.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Goddard J. Physician’s Guide to Arthropods of Medical Importance. Boca Raton, CRC Press, 2000, ed 3.
2. Lofgren CS, Banks WA, Glancey BM. Biology and control of imported fire ants. Ann Rev Entomol 1975;20:1–30.
3. Goddard J, Jarratt J, de Castro FR. Evolution of the fire ant lesion. JAMA 2000;284:2162–2163.
4. Kundrotas L. Images in clinical medicine. Sting of the fire ant (Solenopsis). N Engl J Med 1993;329:1317.
5. Rhoades RB, Schafer WL, Schmid WH, et al. Hypersensitivity to the imported fire ant. A report of 49 cases. J Allergy Clin Immunol 1975; 56:84–93.
6. James FK Jr, Pence HL, Driggers DP, et al. Imported fire ant hypersensitivity. Studies of human reactions to fire ant venom. J Allergy Clin Immunol 1976;58:110–120.
7. Levy AL, Wagner JM, Schuman SH. Fire ant anaphylaxis: two critical cases in South Carolina. J Agromed 1998;5:49–54.
8. Fox RW, Lockey RF, Bukantz SC. Neurologic sequelae following the imported fire ant sting. J Allergy Clin Immunol 1982;70:120–124.
9. deShazo RD, Banks WA. Medical consequences of multiple fire ant stings occurring indoors. J Allergy Clin Immunol 1994;93:847–850.
10. deShazo RD, Williams DF, Moak ES. Fire ant attacks on residents in health care facilities: a report of two cases. Ann Intern Med 1999;131: 424–429.
11. Paull BR. Imported fire ant allergy. Perspectives on diagnosis and treatment. Postgrad Med 1984;76:155–160.
12. Hoffman Dr. Reactions to less common species of fire ants. J Allergy Clin Immunol 1997;100:679–683.
13. Berkel I, Ozsoylu S, Corbacioglu B. Hand-foot syndrome in sickle cell disease. Turk J Pediatr 1966;8:222–231.
14. Ozsoylu S. Hand-foot syndrome in sickle-cell thalessemia. NEJM 1971; 284:219.
15. Karpathios T, Nicolaidou P, Korkas A, Thomaidis T. The hand-foot syndrome in sickle cell beta-thalassemia disease. JAMA 1977;38:1540–1541.
16. Chaturvedi P. Hand foot syndrome in sickle cell anaemia (two case reports). Indian Pediatrics 1977;14:491–493.
17. Babhulkar SS, Pande K, Babhulkar S. The hand-foot syndrome in sickle-cell haemoglobinopathy. J Bone Joint Surg Br 1995;77:310–312.
18. Bennett OM. Salmonella osteomyelitis and the hand-foot syndrome in sickle cell disease. J Pediatr Orthop 1992;12:534–538.
19. Greene WB, McMilland CW. Salmonella osteomyelitis and hand-foot syndrome in a child with sickle cell anemia. J Pediatr Orthop 1987;7: 716–718.
20. Nagore E, Insa A, Sanmartin O. Antineoplastic therapy-induced palmar plantar erythrodysesthesia (‘hand-foot’) syndrome. Incidence, recognition and management. Am J Clin Dermatol 2000;1:225–234.
21. Lin E, Morris JS, Ayers GD. Effect of celecoxib on capecitabine-induced hand-foot syndrome and antitumor activity. Oncology 2002;16:31–37.
22. Abushullaih S, Saad ED, Munsell M, et al. Incidence and severity of hand-foot syndrome in colorectal cancer patients treated with capecitabine: a single-institution experience. Cancer Invest 2002;20:3–10.
23. Laack E, Mende T, Knuffmann C, et al. Hand-foot syndrome associated with short infusions of combination chemotherapy with gemcitabine and vinorelbine. Ann Oncol 2001;12:1761–1763.
24. Hoff PM, Valero V, Ibrahim N, et al. Hand-foot syndrome following prolonged infusion of high doses of vinorelbine. Cancer 1998;82:965–969.
25. Arai K, Iwasaki Y, Kimura Y, et al. A patient with recurrent gastric cancer who developed TS-1 induced hand-foot syndrome. Gan To Kagaku Ryoho 2003;30:699–702.
26. Elasmar SA, Saad ED, Hoff PM. Case report: hand-foot syndrome indcued by the oral fluoropyrimidine S-1. Jpn J Clin Oncol 2001;31:172–174.
27. Jansman FG, Sleijfer DT, de Graaf JC, et al. Management of chemotherapy-induced adverse effects in the treatment of colorectal cancer. Drug Saf 2001;24:353–67.
