Asymptomatic acute myocardial injury during allergic reaction to hymenoptera venom

Excerpt

A 58-year-old man was admitted to the emergency department (ED) with the complaint of generalized pruritis, profuse sweating, malaise and presyncope that had started after being stung by a wasp on his left shoulder around 3 h prior, and worsened with time. He denied chest or abdominal pain. He had no history of cardiac risk factors or allergy, and he was taking no regular medications. Hypotension (90/60 mmHg) was observed. The room air arterial oxygen saturation was of 97%, the heart rate was 69 beats/min. and regular, body temperature was 36.3°C. Except for diaphoresis, the physical examination was normal. Treatment was started with 1 g of hydrocortisone sodium succinate, 10 mg of chlorphenamine and 50 mg of ranitidine intravenously, with subsequent normalization of the blood pressure (122/84 mmHg). No adrenaline was administered. The electrocardiogram did not show signs of ischemia (Fig. 1a). Because of the possible relation between allergic reactions and myocardial ischemia, cardiac biomarkers were determined. Blood tests revealed increased values of troponin I (1.53 ng/mL; reference range (RR) 0–0.06), creatine kinase–MB fraction (23.2 ng/mL; RR <6 ng/mL) and myoglobin (229.5 ng/mL; RR ≤90 ng/mL). Moreover, a blood count revealed leukocytosis (20,920/mm³; RR 4,000–11,000) with no increased number of eosinophils (20/mm³; RR 0–400) or basophils (10/mm³; RR 0–50). C-reactive protein was also increased (4.60 mg/dL; RR 0–1). A coagulation screening showed an increase of the D-dimer (659 ng/mL; RR 0–230). The remaining parameters, renal and liver function, electrolytes, lipid profile, serum proteins electrophoresis, total creatine kinase, Antithrombin III, were within normal limits. A chest X-ray study was normal.

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