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Rhabdomyolysis and Acute Renal Failure After Fire Ant Bites
Supriya Koya, MD 1,3, Daryl Crenshaw, MD 1, and Anupam Agarwal, MD 2
1Internal Medicine Residency Program, University of Alabama at Birmingham, Montgomery, AL 36116, USA; 2Division of Nephrology, ZRB 614, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294, USA; 3UAB Internal medicine residency program, 4371 Narrow lane road, Suite 200, Montgomery, AL 36116, USA.
We describe a 59-year-old patient who developed acute renal failure because of rhabdomyolysis after extensive red fire ant bites. This case illustrates a serious systemic reaction that may occur from fire ant bites. Consistent with the clinical presentation in rhabdomyolysis associated with non-traumatic causes, hyper-kalemia, hypophosphatemia, hypocalcemia, and high anion gap acidosis were not observed in this patient. While local allergic reactions to fire ant bites are described in the literature, serious systemic complications with rhabdomyolysis and renal failure have not been previously reported. It is our effort to alert the medical community of the possibility of such a complication that can occur in the victims of fire ant bites.
KEY WORDS: rhabdomyolysis; acute renal failure; fire ant. DOI: 10.1007/s11606-006-0025-z 2007 Society of General Internal Medicine 2007;22:145147
INTRODUCTION
Rhabdomyolysis occurs after crush injury because of trauma, excessive muscle activity, hereditary muscle disorders, drugs, toxins, metabolic and endocrine disorders, infections, and hyperthermia.1,2 Rare cases of rhabdomyolysis have been described after insect stings (e.g., wasps, bees) and snake bites.35 While local allergic responses to fire ants are well-known, systemic reactions such as anaphylaxis, with life threatening laryngeal edema, bronchospasm, and hypotension, are less common.511 Seizures, serum sickness, and nephritic syndrome have also been reported with fire ant bites 6,11,12.
Herein, we report an unusual case of acute renal failure because of rhabdomyolysis after red fire ant bites to alert the medical community of this rare complication that may occur in the victims with multiple fire ant bites.
CASE REPORT
A 59-year-old African-American male with a past medical history of hypertension, hepatitis C, and a right nephrectomy
for a benign renal cyst, presented to the emergency department in an unresponsive state. The patient was last seen and noted to be well 11 hours before presentation. On the day of admission, he was found unresponsive lying supine on the floor...