Acquired perforating collagenosis (APC) is a rare dermatological condition characterized by the spontaneous eruption of skin-colored or erythematous papules or nodules that eventually ulcerate and exude collagenous material. The exact etiology of APC remains unclear, although various triggers, including infections, medications, autoimmune diseases, and trauma, have been implicated.

This case report presents a 63-year-old female with a history of diabetes who developed erythematous papules and plaques topped with thick, yellowish, hyperkeratotic, adherent crusts on the upper back following an insect bite. Histopathological examination confirmed the diagnosis of APC, characterized by a cup-shaped invagination in the epidermis containing degenerated collagen bundles and basophilic material. Masson-trichrome staining showed transepidermal elimination of the collagen fibers. Patient was initially prescribed tretinoin 0.1% cream to be applied 2x a day. However, patient was not able to apply prescribed medications. Interestingly, without any specific treatment, the patient’s symptoms gradually improved over 3 months and eventually resolved completely.

This case report highlights the spontaneous resolution of APC in a patient following an insect bite. While most cases of APC require medical intervention, this case demonstrates the potential for spontaneous healing in certain individuals. Further research is needed to understand the factors that influence the course of APC and to identify potential predictors of spontaneous resolution.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Collagen ; Insect Bites ; Insect Bites And Stings

Humans ; Herpesvirus 4, Human ; Insect Bites and Stings ; Killer Cells, Natural ; Epstein-Barr Virus Infections ; Neoplasms ; Lymphoproliferative Disorders

Most insects have a stinging apparatus at the tail end of their abdominal segment and can deliver venom. The venom can usually result in pain, erythema, abscess, or allergic reaction in human tissues such as the skin and even the lips. The presentation of lip abscess, especially in the vermilion, is rare and needs to be appropriately managed. A 39-year-old prediabetic male presented with a swollen right lower lip stung by an insect six days before the consult. The swelling started as a vesicle which became bigger, then burst, exuding a yellowish fluid and blood. The swollen area became more significant, and pain was felt. The clinical presentation was that of a lower lip abscess. Adequate antibiotics were prescribed along with a corticosteroid and a topical antiseptic. The treatment was essential to prevent the dissemination of infection and the likelihood of tissue necrosis. This case report is presented as a rare clinical case of a lower lip abscess due to an insect sting with spontaneous drainage after treatment in a prediabetic male. The dentist and clinician needed to identify this condition and to manage the case properly.
Insect Bites and Stings

Patients with chronic lymphocytic leukemia (CLL) rarely exhibit an exaggerated insect bite-like reaction without a history of an arthropod bite. We report a case of an insect bite-like reaction in a 74-year old man with CLL. The patient presented with a 2-year history of recurrent itchy erythematous patches and blisters on the whole body. He had been diagnosed with CLL 2 years ago, and the skin lesions developed 1 month after remission. The result of a skin biopsy was consistent with insect bite. Immunohistochemical staining of the infiltrated cells showed positive reactions for CD3, CD5 and negative for CD20, CD23. Direct and indirect immunofluorescence revealed negative results. The patient was treated with oral prednisolone and dapsone, under the diagnosis of CLL-associated insect bite-like reaction, and showed marked improvement. Dermatologist should be aware of insect bite-like reaction associated with CLL as a distinct disease entity that is similar to insect bite or bullous pemphigoid.
Arthropods ; Biopsy ; Blister* ; Dapsone ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Insect Bites and Stings ; Insects* ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Pemphigoid, Bullous* ; Prednisolone ; Skin

BACKGROUNDVenom allergy is significantly underestimated in China. Venom-specific IgE may not provide accurate clinical reactions. Our conducted retrospective analysis observes alternative diagnostic considerations in assessing confirmation and severity of honeybee venom allergy.

METHODSRetrospective review of honeybee venom allergy versus nonallergy patients presented with positive honeybee venom (i1) sIgE results. According to clinically observed reactions caused by a honeybee sting, patients were divided into three groups. Patient residence and exposure types were analyzed. The sIgE/T-IgE among allergy and control groups was compared.

RESULTSGender ratio male:female was 32:22; median age was 39 years (31, 50). 48% (26/54) of patients live in urban areas, 52% (28/54) in rural areas. Based on bee sting reactions, patients were divided into common localized reactions (32/54), large localized reactions (7/54), and systemic reactions (15/54). In the systemic reaction group, patients presented as Type II (6/15), Type III (6/15). There is significant difference (P < 0.001) between the three groups in regards to exposure types. In the systemic reaction group, 8.7% (13/15) of patients are beekeepers. A significant difference (P < 0.001) was observed between allergic and control groups based on sIgE/T-IgE results. As well as significant difference observed between the systemic reaction group to the other two reaction groups in regards to sIgE/T-IgE results. Six systemic reaction patients presented with large localized reactions before onset of system symptoms 1 month to 1 year of being stung.

CONCLUSIONSOccupational exposure is the most common cause in honeybee venom allergy induced systemic reactions. The use of sIgE/T-IgE results is a useful diagnostic parameter in determining honeybee venom allergy.

Adult ; Bee Venoms ; immunology ; Beekeeping ; China ; Female ; Humans ; Hypersensitivity ; blood ; immunology ; Immunoglobulin E ; blood ; immunology ; Insect Bites and Stings ; immunology ; Male ; Middle Aged ; Occupational Diseases ; Occupational Exposure ; adverse effects ; Retrospective Studies

Adolescent ; Adult ; Aged ; Bloodletting ; Child ; Child, Preschool ; Combined Modality Therapy ; Dermatitis ; therapy ; Female ; Humans ; Infant ; Insect Bites and Stings ; therapy ; Lymphangitis ; therapy ; Male ; Middle Aged ; Moxibustion ; Young Adult

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

Reactions to Hymenoptera stings are classified into local reactions, large local reactions, systemic anaphylactic reactions, systemic toxic reactions, and unusual reactions. They are also classified into immediate and delayed reactions. The most frequent clinical patterns are large local and systemic anaphylactic reactions. The skin, and the gastrointestinal, respiratory, and cardiovascular systems can be involved. A variety of unusual or unexpected reactions, such as acute encephalopathy, acute renal failure, nephrotic syndrome, silent myocardial infarction, diffuse alveolar hemorrhage, rhabdomyolysis, and cataracts, occur in a temporal relationship to insect stings. Here, we report a 31-year-old woman with delayed generalized edema, weight gain, and unusual reactions 24 hours after bee sting.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Bees ; Bites and Stings* ; Brain Diseases ; Cardiovascular System ; Cataract ; Edema ; Female ; Hemorrhage ; Humans ; Hymenoptera* ; Insect Bites and Stings ; Myocardial Infarction ; Nephrotic Syndrome ; Rhabdomyolysis ; Skin ; Weight Gain

Travel-related health problems such as febrile illness have been reported in many travelers going to developing countries. With the emergence of new infectious diseases occurring in many parts of the world and their spread worldwide, early diagnosis of emerging infectious diseases or tropical diseases has become a very important part of controlling these diseases. In doing so, the itinerary of the ill returning traveler is crucial to formulating a differential diagnosis because exposure to pathogens differs depending on the area of travel. With up-to-date information on infectious diseases occurring worldwide, a differential diagnosis can be made by adding information on duration of travel, incubation period, underlying medical illness, history of prophylactic vaccines received, and knowledge of the patient's exposures during travel including insect bites, contaminated food or water, or freshwater swimming. Some travelers may have specific symptoms and signs such as fever, rash, or hemorrhagic manifestations. For example, eosinophilia suggests a possible helminth infection. In this article, the general approach to returnning travelers with suspected tropical disease will be described.
Communicable Diseases ; Communicable Diseases, Emerging ; Dengue ; Developing Countries ; Diagnosis, Differential* ; Early Diagnosis ; Eosinophilia ; Exanthema ; Fever ; Fresh Water ; Helminths ; Insect Bites and Stings ; Malaria ; Swimming ; Travel Medicine ; Vaccines ; Water

PURPOSE: Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. METHODS: To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea. RESULTS: A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases. CONCLUSIONS: The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes.
Adult* ; Anaphylaxis* ; Anti-Bacterial Agents ; Epidemiology ; Epinephrine ; Hospitals, University ; Humans ; Incidence ; Insect Bites and Stings ; Korea ; Length of Stay ; Male ; Medical Records ; Prevalence ; Retrospective Studies* ; Seasons