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Case Report: Late-Onset Pneumonitis after Apoica pallida (Insecta: Hymenoptera) Sting with Anaphylactic Reaction in the Brazilian Amazon

Guilherme Augusto Pivoto JoãoFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;
Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil;

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Paula BonatesFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;

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Thelma Silva de AraújoFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;

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Aline AlencarFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;

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Érica da Silva CarvalhoUniversidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil;

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Djane Clarys Baia-da-SilvaFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;
Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil;
Universidade Federal do Amazonas, Programa de Pós-Graduação em Assistência Farmacêutica, Manaus, Brazil;
Instituto Leônidas & Maria Deane, Manaus, Brazil;

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Jacqueline de Almeida Gonçalves SachettFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;
Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil;
Fundação Alfredo da Matta, Diretoria de Ensino e Pesquisa, Manaus, Brazil

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Wuelton Marcelo MonteiroFundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil;
Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil;

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ABSTRACT.

Hymenopteran venoms, inoculated during stings by ants, bees, and wasps, are the most frequent cause of an IgE-mediated systemic hypersensitivity reaction in adults, which is a key process in drastic manifestations of anaphylaxis. Respiratory involvement is usually caused by pulmonary edema but is rarely described as including interstitial pneumonitis or acute respiratory distress syndrome. Here, we describe a case of severe allergic reaction after a sting by Apoica pallens with late-onset pulmonary involvement, including signs of vasoplegia (pleural effusion) and interstitial pneumonitis with mild rhabdomyolysis. The presence of late onset of pulmonary involvement after a severe allergic reaction after a sting by A. pallens shows the importance of keeping a patient with severe reactions under medical care for a minimum of 5 days to avoid serious late complications outside the hospital environment.

Author Notes

Address correspondence to Wuelton Marcelo Monteiro, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Av. Pedro Teixeira, s/n - Dom Pedro, Manaus - AM, 69040-000. E-mail: wueltonmm@gmail.com

Financial support: This research was funded by the Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEM): Universal Amazonas (#002/2018), Pro-Estado Program (#002/2008, #007/2018, #005/2019) and POSGRAD 2020 Program (#006/2020).

Authors’ addresses: Guilherme Augusto Pivoto João and Wuelton Marcelo Monteiro, Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira, Manaus, Brazil, and Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil, E-mails: guilhermepivoto@hotmail.com and wueltonmm@gmail.com. Paula Bonates, Thelma Silva de Araújo, Aline and Alencar, Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira, Manaus, AM, Brazil, E-mails: paaulabonates@hotmail.com, thelmasaraujo@terra.com.br, and alencaraline.med@gmail.com. Érica da Silva Carvalho, Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil, E-mail: carvalhouea@gmail.com. Djane Clarys Baia-da-Silva, Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira, Manaus, AM, Brazil, Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil, Universidade Federal do Amazonas, Programa de Pós-Graduação em Assistência Farmacêutica, Manaus, Brazil, Instituto Leônidas & Maria Deane, Manaus, Brazil, E-mail: djane.claryss@gmail.com. Jacqueline de Almeida Gonçalves Sachett, Fundação de Medicina Tropical Dr. Heitor Vieira, Departamento de Ensino e Pesquisa, Manaus, Brazil, Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, Brazil, Fundação Alfredo da Matta, Diretoria de Ensino e Pesquisa, Manaus, Brazil, E-mail: jac.sachett@gmail.com.

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