Imported fire ants are aggressive, venomous ants that sting with little provocation and are difficult to avoid in endemic areas. The patient was felt to be in complete remission. Her erythrocyte sedimentation rate was 15 mm/h C-reactive protein, <0.3mg/dL and complete blood count normal without evidence of blood dyscrasia, and antineutrophil cytoplasmic antibody remained negative. Recent follow-up 1 year after the last dose of prednisone showed complete resolution of all swelling, with mild residual post-inflammatory hyperpigmentation. The swelling in her leg improved over the next 4 months except for mild residual venous stasis dermatitis and edema. The prednisone was tapered and eventually stopped over the next 4 months. A magnetic resonance image (MRI) of the lower extremity, done 8 months into the illness to help determine the activity of EF, revealed only skin and soft tissue edema involving the distal two-thirds of the right leg below the knee, compatible with venous insufficiency the inflammatory changes had resolved. She was then evaluated at Ochsner Medical Center's Department of Rheumatology. She was placed on 30 mg of prednisone, which was tapered to 10 mg over the next month. The patient presented to a rheumatologist at that time. Based on the clinical features and biopsy results, a diagnosis of EF was made. There was also evidence of thickening of the septa between subcutaneous lobules of fat ( Figure 1). A dermatologist performed a punch biopsy of the skin from above the right ankle, which revealed dermal edema with chronic inflammation including eosinophils. She then saw a vascular physician who wrapped her leg but did not do any further studies. The bronchitis resolved, but the redness and swelling in her right lower extremity did not improve. For an episode of bronchitis, she was given several courses of the antibiotics clarithromycin and doxycycline. Her erythrocyte sedimentation rate was 4 mm/h C-reactive protein, 0.5 mg/dL creatine phosphokinase, normal at 62 ยต/L and complete blood count normal without eosinophils noted on the peripheral smear. She underwent further evaluation, including a venous Doppler, which was negative for venous thrombosis. The swelling in her right leg was associated with induration and thickening of the skin. The ant bites occurred in the right ankle and dorsal foot, and the lower extremity induration was above the ankle and proximal to the site of the bites. One week later, she noted swelling of her right leg extending from above the ankle to a few inches below her knee. A 79-year-old woman, while barefoot in her backyard in New Orleans cleaning up debris shortly after Hurricane Katrina, suffered numerous fire ant bites to the right dorsal foot and ankle.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |