PMID- 30755855
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 2284-2594 (Electronic)
IS  - 2284-2594 (Linking)
VI  - 3
IP  - 2
DP  - 2016
TI  - A Very Big Hand Is a Very Big Problem: Soft-Tissue Infection, Venous Thrombosis, 
      or Just an Insect Sting?
PG  - 000312
LID - 10.12890/2016_000312 [doi]
LID - 000312
AB  - A 67-year-old woman developed severe edema of her right hand and forearm, for 
      which she was treated with antibiotics, without benefit. The echography excluded 
      a venous thrombosis. Subsequently, she referred a wasp sting before the 
      development of the edema. Specific Hymenoptera venom immunoglobulin E (IgE) was 
      found to be positive for paper wasp and yellow jacket. A large local reaction 
      (LLR) was diagnosed due to the hymenoptera sting. Self-injectable epinephrine was 
      prescribed for possible, though unlikely, systemic reactions following 
      hymenoptera stings. LEARNING POINTS: The differential diagnosis of an upper 
      forearm and hand oedema may be challenging.In order to reach the correct 
      diagnosis and to prescribe proper treatment, careful examination and history 
      taking is essential.All possible causes should be taken into proper 
      consideration.Large local reaction (LLR) is characterized by hot, flushed and 
      thick edema after a hymenoptera sting. As the risk of a systemic reaction, upon 
      the first sting following a consistent index LLR, it is important to recognize an 
      LLR in order to prescribe self-injectable epinephrine to prevent the occurrence 
      of anaphylaxis.
FAU - Damanti, Sarah
AU  - Damanti S
AD  - School of Specialization in Geriatrics and Gerontology, Universita degli Studi di 
      Milano, Milan, Italy.
FAU - Brignolo-Ottolini, Barbara
AU  - Brignolo-Ottolini B
AD  - School of Specialization in Geriatrics and Gerontology, Universita degli Studi di 
      Milano, Milan, Italy.
FAU - Mansi, Marta
AU  - Mansi M
AD  - School of Specialization in Geriatrics and Gerontology, Universita degli Studi di 
      Milano, Milan, Italy.
FAU - Marcucci, Maura
AU  - Marcucci M
AD  - Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 
      Italy.
AD  - Department of Clinical Sciences & Community Health, University of Milan, Milan, 
      Italy.
FAU - Mari, Daniela
AU  - Mari D
AD  - Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 
      Italy.
AD  - Department of Clinical Sciences & Community Health, University of Milan, Milan, 
      Italy.
FAU - Pravettoni, Valerio
AU  - Pravettoni V
AD  - Allergology and Immunology Unit, Fondazione IRCCS Ca' Granda, Osp. Maggiore 
      Policlinico, Milan, Italy.
LA  - eng
PT  - Journal Article
DEP - 20160120
PL  - Italy
TA  - Eur J Case Rep Intern Med
JT  - European journal of case reports in internal medicine
JID - 101648453
PMC - PMC6346946
OTO - NOTNLM
OT  - Large local reaction
OT  - anaphylaxis
OT  - angioedema
COIS- Conflicts of Interests: The authors declare that there are no competing 
      interests.
EDAT- 2016/01/20 00:00
MHDA- 2016/01/20 00:01
PMCR- 2016/01/20
CRDT- 2019/02/14 06:00
PHST- 2015/10/14 00:00 [received]
PHST- 2015/11/16 00:00 [accepted]
PHST- 2019/02/14 06:00 [entrez]
PHST- 2016/01/20 00:00 [pubmed]
PHST- 2016/01/20 00:01 [medline]
PHST- 2016/01/20 00:00 [pmc-release]
AID - 312-1-2511-1-10-20160119 [pii]
AID - 10.12890/2016_000312 [doi]
PST - epublish
SO  - Eur J Case Rep Intern Med. 2016 Jan 20;3(2):000312. doi: 10.12890/2016_000312. 
      eCollection 2016.