Acute stent thrombosis in a sirolimus eluting stent after wasp sting causing acute myocardial infarction: a case report

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Abstract

Introduction

Hymenoptera venoms contain thrombogenic substances that might be responsible for cardiovascular events independent of anaphylactic reactions.

Case presentation

We report a 55-year-old man who experienced an acute ST-elevation myocardial infarction after wasp sting. The patient presented without signs of anaphylaxis or shock. The coronary angiography showed an acute stent thrombosis of the right coronary artery. Percutanous coronary intervention was performed immediately and this is an example for a cardiovascular complication associated with a hymenoptera sting, since the vasoactive, inflammatory, and thrombogenic substances of hymenoptera venoms potentially cause stent thrombosis and myocardial ischemia. To the best of our knowledge this is the first report of acute stent thrombosis in a sirolimus-eluting stent following hymenoptera sting.

Conclusion

Stent thrombosis is a possible complication after wasp sting induced by thrombogenic substances of the hymenoptera venom.

Related collections

Most cited references 12

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Bee and Wasp Venoms

E Habermann (1972)

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Unusual reactions to insect stings.

R E Reisman (2005)

A variety of unusual or unexpected reactions have occurred in a temporal relationship to insect stings. This review will summarize these case history reports in recent years. As these reactions are very infrequent, the review will also include prior reported unusual reactions attributed to insect stings. Acute encephalopathy occurred 8 days after yellow jacket stings, without any other obvious cause. There have been prior reports of other neurological reactions, myasthenia gravis, peripheral neuritis and Guillain-Barré syndrome related to insect stings. Acute renal failure with tubular necrosis has occurred following massive numbers of stings from Africanized honeybees. Nephrotic syndrome has been reported in the past following single stings. Silent myocardial infarction has occurred, probably related to acute anaphylactic symptoms immediately following a sting. There are recent reports of other pathology, diffuse alveolar hemorrhage and rhabdomyolysis and prior reports of thrombocytopenic purpura and vasculitis. As the result of ocular stings, local reactions have occurred with corneal pathology leading to cataracts. Other prior reported reactions to ocular stings include conjunctivitis, corneal infiltration, lens subluxation, and optic neuropathy. There is scarce information regarding the pathogenesis of the majority of the unusual reactions and the subsequent allergic status or risk for sting anaphylaxis of people who have had these unusual reactions. This review includes a variety of reactions, particularly involving neurological, renal and cardiovascular symptoms, related to insect stings. It is important that clinicians be aware of this relationship when assessing people with these reactions and address future prophylaxis.

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Acute myocardial infarction following wasp sting. Report of two cases and critical survey of the literature.

William H. Levine (1976)

Over the span of two or three days in August, 1972, in two separate communities in eastern Massachusetts two men, one aged 39, the other 66, each without previous overt heart disease, were stung by wasps. Each went into shock rapidly after an interval of over a half-hour developed chest pain and, later, sequential electrocardiographic changes diagnostic of acute myocardial infarction. Each survived; each had normal electrocardiograms before the sting. Though preexistent coronary artery disease can be excluded in neither, the view is favored that acute myocardial infarction in each was caused by deficient coronary perfusion secondary to anaphylactic shock induced by the wasp stings. An intriguing case was just recently reported58 of a 62-year-old man with previous angina who developed pulmonary edema but no chest pain following wasp sting and went on to show rapidly reversed electrocardiographic changes attributable to subendocardial ischemia or infarction. In a sense, this sequence fills the gap as an intermediate phase between the normal and the two individuals described here who developed pain after anaphylactic shock, then proceeded, perhaps through this phase, to develop transmural infarction.

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Author and article information

Journal

Journal ID (nlm-ta): Cases J

Title: Cases Journal

Publisher: Cases Network Ltd

ISSN (Electronic): 1757-1626

Publication date (Electronic): 12 August 2009

Publication date Collection: 2009

Volume: 2

Electronic Location Identifier: 7800

Affiliations

[1]simpleDepartment of Cardiology, Ludwig-Maximilians-University Munich, Germany Marchioninistrasse 1581377 MunichGermany

Article

Publisher ID: 7800

DOI: 10.4076/1757-1626-2-7800

PMC ID: 2769374

PubMed ID: 19918484

SO-VID: f116eedc-0090-4cbb-84cf-e60bbcaf6931

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Acute stent thrombosis in a sirolimus eluting stent after wasp sting causing acute myocardial infarction: a case report

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Abstract

Introduction

Case presentation

Conclusion

Related collections

Hymenoptera

Most cited references 12

Bee and Wasp Venoms

Unusual reactions to insect stings.

Acute myocardial infarction following wasp sting. Report of two cases and critical survey of the literature.

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