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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 88-89

Acute transverse myelitis: A rare neurological complication following wasp sting


Department of General Medicine, JIPMER, Dhanvantari Nagar, Puducherry, India

Date of Submission04-Jan-2014
Date of Decision29-Jan-2014
Date of Acceptance29-Jan-2014
Date of Web Publication7-Mar-2014

Correspondence Address:
Kolar Vishwanath Vinod
Department of General Medicine, JIPMER, Dhanvantari Nagar, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128346

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How to cite this article:
Vinod KV, Ponraj M, Swetharani K, Dutta TK. Acute transverse myelitis: A rare neurological complication following wasp sting. Neurol India 2014;62:88-9

How to cite this URL:
Vinod KV, Ponraj M, Swetharani K, Dutta TK. Acute transverse myelitis: A rare neurological complication following wasp sting. Neurol India [serial online] 2014 [cited 2019 Nov 17];62:88-9. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/88/128346


Sir,

Neurological complications following wasp stings are rare. Here, we report a rare case of long segment acute transverse myelitis following a single wasp sting.

A 15-year-old boy was admitted for weakness of all four limbs, diminished sensations below the mid-thoracic level, difficulty in passing urine and constipation of 2 days duration. Seven days prior to onset of weakness, he had been stung by a single wasp over the abdomen, when he had tried to disturb a wasp nest. He had pain, local swelling and redness at the sting site, lasting several hours. On examination, he was conscious, had flaccid quadriparesis (power in upper limbs grade 2-3/5 and lower limbs 2/5) with truncal weakness, diminished deep tendon reflexes in upper limbs and preserved reflexes in the lower limbs, extensor plantar responses and normal optic fundi. Sensations were reduced below T-4 dermatomal level. Magnetic resonance imaging of the spine revealed hyperintensity within the spinal cord adjoining C-5 to D-4 vertebrae in T 2 -weighted images [Figure 1], confirming long segment acute transverse myelitis. Cerebrospinal fluid showed 0.02 × 10 9 cells/l (all lymphocytes), protein: 0.60 g/l, glucose: 0.78 g/l and no oligoclonal band. MRI of brain, nerve conduction studies, visually evoked potentials, neuromyelitis optica-IgG antibodies, work-up for other autoimmune disorders and viral infections associated with myelitis were unremarkable. He received intravenous methylprednisolone 750 mg/day for 3 days, followed by oral prednisolone 45 mg/day (1 mg/kg) for 1 month. He showed complete neurological recovery at 1 month and prednisolone was tapered over next 6 weeks. He is doing well at 12 months follow-up.
Figure 1: Magnetic resonance imaging of spinal cord (sagittal view) showing normal spinal cord in T1-weighted image (a) and hyperintensity within the cord adjoining C-5 to D-4 vertebrae in T2-weighted image (b), suggesting long segment acute transverse myelitis

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Wasp stings have been rarely reported to cause neurological complications such as acute encephalitis, acute myelitis, encephalomyelitis, cerebral infarction, exacerbation of multiple sclerosis, seizures, acute inflammatory polyradiculoneuropathy (Guillain-Barre syndrome [GBS]), myeloradiculopathy, optic neuritis, myasthenia gravis, autoimmune neuromyotonia, cavernous sinus thrombosis and parkinsonism. [1],[2],[3],[4],[5],[6] Quadriparesis following wasp sting can result from acute myelitis, GBS, brainstem encephalitis/infarction and hypokalemia. Hypokalemia resulting from renal tubular acidosis has been reported to cause quadriparesis, following wasp sting. [5] Although acute myelitis has been reported in association with polyradiculoneuropathy and encephalitis, [2] isolated myelitis following hymenoptera sting is very rare and to the best of our knowledge has been reported in only one earlier report. [6]

Pathogenesis of neurological complications is unclear but may involve direct neurotoxic effect of venom, IgE mediated immediate hypersensitivity, delayed immunological responses to wasp venom antigens leading to autoimmune reaction by antigenic cross reactivity to human myelin basic protein. [1],[2],[4] Latency period of hours to weeks has been reported between the wasp sting and onset of neurological event. [1] In the present patient, delayed hypersensitivity to venom antigens [4] might have contributed to acute demyelinating myelitis. Systemic steroids are useful for treating complications such as optic neuritis, acute myelitis and encephalitis, where demyelination plays a vital role in the pathogenesis. [1],[2],[3] Plasma exchange may be useful when there is incomplete response to steroids. [2]

 
  References Top

1.Bánovcin P, Havlíceková Z, Jesenák M, Nosál S, Durdík P, Ciljaková M, et al. Severe quadriparesis caused by wasp sting. Turk J Pediatr 2009;51:485-8.  Back to cited text no. 1
    
2.Likittanasombut P, Witoonpanich R, Viranuvatti K. Encephalomyeloradiculopathy associated with wasp sting. J Neurol Neurosurg Psychiatry 2003;74:134-5.  Back to cited text no. 2
    
3.Maltzman JS, Lee AG, Miller NR. Optic neuropathy occurring after bee and wasp sting. Ophthalmology 2000;107:193-5.  Back to cited text no. 3
    
4.Ridolo E, Albertini R, Borghi L, Meschi T, Montanari E, Dall′Aglio PP. Acute polyradiculoneuropathy occurring after hymenoptera stings: A clinical case study. Int J Immunopathol Pharmacol 2005;18:385-90.  Back to cited text no. 4
    
5.D′Cruz S, Chauhan S, Singh R, Sachdev A, Lehl S. Wasp sting associated with type 1 renal tubular acidosis. Nephrol Dial Transplant 2008;23:1754-5.  Back to cited text no. 5
    
6.Defer G, Cesaro P, Roualdes B, Degos JD. Acute myelitis following Hymenoptera sting. Presse Med 1984;13:227.  Back to cited text no. 6
    


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