Shark attacks are rare unique pathological processes. Some of them represent devastating injuries with a high morbidity and significant mortality. Related published articles are limited. The increased human interaction within the environment of sharks is the cause of rising incidence of such attacks. This study reported a case of level 4 shark injuries (shark-induced trauma scale) in a 33-year-old male patient, who presented with an extensive injury of the right lower limb with the characteristic features of shark bite. At admission the patient was in a state of shock with profuse bleeding that was controlled by tourniquet. The patient was resuscitated according to the advanced trauma life support. Clinical examination showed hard signs of vascular injury with absent pedal pulse, associated neurological deficits and severance at the knee joint. Prompt vascular intervention after resuscitation was performed to manage the major vascular injuries, together with proper washout and debridement of all the necrotic tissues under strong antibiotic coverage to prevent infection. After that, the patient underwent sequenced plastic, orthopedic, and neurological interventions. Strict follow-up was conducted, which showed that the patient was saved and achieved a functioning limb. This study aims to highlight the management of level 4 shark injuries, which are considered serious and challenging with a high fatality rate and a great risk of amputation due to the associated major vascular injuries. Immediate well organized management plan is crucial. Prompt resuscitation and surgical intervention by a highly-skilled medical team are required to improve the chance of patient survival and limb salvage.
Adult ; Animals ; Bites and Stings/complications* ; Humans ; Limb Salvage ; Male ; Retrospective Studies ; Sharks ; Vascular System Injuries/surgery*

Acute Coronary Syndrome ; etiology ; Administration, Intravenous ; Anaphylaxis ; drug therapy ; Animals ; Bees ; Epinephrine ; administration & dosage ; Humans ; Insect Bites and Stings ; complications ; Male ; Middle Aged

OBJECTIVETo study the clinicopathologic features, immunophenotype and gene rearrangement of primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL).

METHODSSeven cases of PCLBCL were enrolled into the study. Clinicopathologic analysis, immunohistochemical staining and gene rearrangement for IgH and Igκ were undertaken in the study.

RESULTSAll the seven cases were male, and the median age was 72 years. Patients usually presented with multiple purple tumors, nodules, papules and infiltrative plaques. Two patients had a history of leg injury before onset, and one had mosquito bites. Histologically, the tumor involved the dermis and subcutis with dense and diffuse infiltrative pattern composing of centroblasts and/or immunoblasts. Immunohistochemical staining showed that seven cases (7/7) expressed CD20, six (6/6) expressed bcl-2, four (4/4) expressed MUM-1, four (4/5) expressed CD79a, four (4/5) expressed PAX-5 and four (4/6) expressed bcl-6, respectively. All cases did not express CD3ε, CD45RO, CD10 and CD30. IgH gene rearranged bands were detected in three (3/6) cases and Igκ was detected in one (1/5) case. Six of the seven cases died and the remaining patient, who was 44-year-old, was alive after 22 months of follow-up.

CONCLUSIONSPCLBCL is rare, predominantly affects elderly male patients. PCLBCL has poor prognosis and high mortality, but younger patients seem to have better prognosis. Some cases had a history of trauma or mosquito bites. The relationship between the history and the onset of PCLBCL needs further evaluation.

Aged ; Aged, 80 and over ; Animals ; Antigens, CD ; analysis ; Culicidae ; Gene Rearrangement ; Humans ; Immunoglobulin Heavy Chains ; genetics ; Immunoglobulin kappa-Chains ; genetics ; Immunophenotyping ; Insect Bites and Stings ; complications ; Leg ; Leg Injuries ; complications ; Lymphoma, Large B-Cell, Diffuse ; genetics ; metabolism ; pathology ; Male ; Middle Aged ; Prognosis ; Proto-Oncogene Proteins c-bcl-6 ; metabolism ; Skin Neoplasms ; genetics ; pathology

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense skin reactions such as bulla and necrotic ulcerations at bite sites, accompanied by general symptoms such as high-grade fever and malaise occurred after mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer (NK) cell leukemia/lymphoma. We describe here a Korean child who presented with 3-yr history of HMB without natural killer cell lymphocytosis. He has been ill for 6 yr with HMB. Close observation and examination for the development of lymphoproliferative status or hematologic malignant disorders is needed.
Child ; Epstein-Barr Virus Infections/complications ; Humans ; Hypersensitivity/*diagnosis/etiology ; Insect Bites and Stings/*diagnosis/pathology ; Killer Cells, Natural/immunology ; Lymphocytosis/complications/pathology ; Male ; Republic of Korea ; Skin/pathology

Aged ; Anaphylaxis ; etiology ; Animals ; Female ; Humans ; Insect Bites and Stings ; complications ; Myocardial Infarction ; etiology ; Wasps

We reported a case of multiple organ dysfunction syndrome (MODS) following about 300 wasp stings. The diagnosis was based on autopsy findings of acute pulmonary edema, acute kidney injury, hepatic and cardiac dysfunction, and cerebral edema. MODS is a life-threatening complication, and should be considered a possibility after multiple wasp stings. Our autopsy helped to establish the cause of unexpected death due to wasp stings and to elucidate a possible mechanism of MODS.
Adult ; Animals ; Fatal Outcome ; Female ; Humans ; Insect Bites and Stings ; complications ; Multiple Organ Failure ; etiology ; Wasps

Skin necrosis of the foot, oedema and lymphangitis from stonefish (Synanceia verrucosa) sting are complications well known for a long time and with potential long-term sequelae. Literature reports of stonefish envenomation give no specific reference on soft tissue management and surgical reconstruction. This is the first report describing a case of foot stonefish envenomation treated by vacuum-assisted closure therapy as an easy to use, accessible and simple adjuvant tool for management of large soft tissue necrosis.
Animals ; Bites and Stings ; complications ; surgery ; Dermatologic Surgical Procedures ; Fishes, Poisonous ; Foot Injuries ; surgery ; Humans ; Lymphangitis ; etiology ; surgery ; Male ; Middle Aged ; Necrosis ; Negative-Pressure Wound Therapy ; Skin ; pathology ; Skin Transplantation

Hypersensitivity to mosquito bites (HMB) is a disorder characterized by a necrotic skin reaction and generalized symptoms subsequent to mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer cell leukemia/lymphoma. We describe here a Korean child who had HMB associated with chronic EBV infection and natural killer cell lymphocytosis. A 5-yr-old boy was suffered from necrotic skin lesions on the right ear lobe. Type A EB virus was detected from hlood cells and bone marrow biospy recognized hemophagocyrosis.
Animals ; Child, Preschool ; Culicidae/*immunology ; Epstein-Barr Virus Infections/complications/*diagnosis ; Herpesvirus 4, Human/genetics/isolation & purification ; Humans ; Hypersensitivity/complications/*diagnosis ; Insect Bites and Stings/complications/*immunology ; Killer Cells, Natural/immunology/*pathology ; Lymphocytosis/complications/*diagnosis ; Male ; Polymerase Chain Reaction

Adolescent ; Animals ; Bees ; Child ; Child, Preschool ; Female ; Hemodiafiltration ; adverse effects ; methods ; Humans ; Infant ; Insect Bites and Stings ; complications ; Male ; Multiple Organ Failure ; therapy

We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.
Actinomycetales Infections/diagnosis/microbiology ; Adult ; Animals ; Anti-Bacterial Agents/therapeutic use ; Arcanobacterium ; Bites and Stings/*complications ; Clindamycin/therapeutic use ; Diabetes Mellitus/diagnosis/therapy ; *Dogs ; Fasciitis, Necrotizing/diagnosis/drug therapy/*microbiology ; Female ; Gram-Positive Bacterial Infections/diagnosis/microbiology ; Humans ; Penicillin G/therapeutic use ; Peptostreptococcus ; Streptococcal Infections/diagnosis/microbiology ; Streptococcus agalactiae