A rare neurological manifestation of seizure in a case of anaphylaxis following a hornet sting: case report & literature review

Abstract

Anaphylaxis is a severe, life-threatening allergic reaction that can present with a variety of systemic manifestations. Neurological symptoms such as seizures or seizure-like activity are uncommon in anaphylaxis. We present the case of a healthy young male with no history of seizures who experienced anaphylaxis following a hornet sting, manifested by urticarial rashes, facial flushing, and generalized pruritus. Interestingly, he developed seizure-like activity, characterized by focal jerky movement of the left upper limb with impaired consciousness as reported by eyewitnesses. This case highlights the atypical presentation of neurological manifestations of anaphylaxis, discusses its potential pathophysiological mechanisms, and reflecting individualized management approach in relation to established guidelines.

Keywords

• Anaphylaxis
• wasp sting
• hornet sting
• seizure
• neurological manifestations

Supporting Institution

University of Science Malaysia

Project Number

1

Ethical Statement

Written informed consent was obtained from the patient for the publication of this case. Ethical approval was not required for this single-patient case report as per institutional policy.

Thanks

Thank you.

Eşek arısı sokmasına bağlı anafilaksi vakasında nadir bir nörolojik bulgusu olarak nöbet: olgu sunumu ve literatür incelemesi

Abstract

Anafilaksi, çeşitli sistemik belirtilerle ortaya çıkabilen, şiddetli ve yaşamı tehdit eden bir alerjik reaksiyondur. Nörolojik semptomlar, örneğin nöbetler veya nöbet benzeri aktiviteler, anafilakside nadir görülür.
Bu yazıda, eşek arısı sokması sonrası anafilaksi gelişen, nöbet öyküsü olmayan sağlıklı bir genç erkek olgusu sunulmaktadır. Hastada ürtiker döküntüleri, yüzde kızarıklık ve yaygın kaşıntı şeklinde belirtiler gelişmiştir. İlginç bir şekilde, görgü tanıklarının aktardığına göre, bilinç bozukluğu ile birlikte sol üst ekstremitede fokal sarsıntılı hareketlerle karakterize nöbet benzeri bir aktivite gözlemlenmiştir. Bu olgu, anafilaksinin atipik nörolojik belirtilerle seyredebildiğini vurgulamakta ve bu semptomların olası patofizyolojik mekanizmaları üzerine tartışma sunmaktadır.

Keywords

• Anafilaksi
• yaban arısı sokması
• eşek arısı sokması
• nöbet
• nörolojik bulgular

Project Number

1

References

1. Simons FE, Ardusso LR, Bilò MB, et al. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. 2011;127(3):587-593e22. doi:10.1016/j.jaci.2011.01.038
2. Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi:10.1016/j.anai.2015.07.019
3. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000;30(8):1144-1150. doi:10.1046/j.1365-2222.2000.00864.x
4. Worm M, Francuzik W, Renaudin JM, et al. Factors increasing the risk for a severe reaction in anaphylaxis: An analysis of data from The European Anaphylaxis Registry. Allergy. 2018;73(6):1322-1330. doi:10.1111/all.13380
5. Golden DB. Insect sting anaphylaxis. Immunol Allergy Clin North Am. 2007;27(2):261-vii. doi:10.1016/j.iac.2007.03.008
6. Turner PJ, Campbell DE, Boyle RJ, Levin ME. Primary Prevention of Food Allergy: Translating Evidence from Clinical Trials to Population-Based Recommendations. J Allergy Clin Immunol Pract. 2018;6(2):367-375. doi:10.1016/j.jaip.2017.12.015
7. Kemp SF, Lockey RF, Simons FE; World Allergy Organization ad hoc Committee on Epinephrine in Anaphylaxis. Epinephrine: the drug of choice for anaphylaxis. A statement of the World Allergy Organization. Allergy. 2008;63(8):1061-1070. doi:10.1111/j.1398-9995.2008.01733.x
8. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006;26(3):451-463. doi:10.1016/j.iac.2006.05.010

9. Kharal GA, Darby RR, Cohen AB. Envenomation seizures. Neurohospitalist. 2018;8(1):29-30. doi:10.1177/1941874417737016
10. Banks WA. The blood-brain barrier in neuroimmunology: Tales of separation and assimilation. Brain Behav Immun. 2015;44:1-8. doi:10.1016/j.bbi.2014.08.007
11. Yang S, Wellington J, Chen J, et al. Cerebral infarction following bee stings: Case report and literature review. Transl Neurosci. 2022;13(1):163-171. doi:10.1515/tnsci-2022-0225
12. Du G, Yang X, Du X. Posterior reversible encephalopathy syndrome following multiple wasp stings: a case report. Int J Clin Exp Med. 2017;10(1):1446-1448.
13. Maramattom BV. Wasp sting-related allergic encephalitis. Pract Neurol. 2021;21(6):515-517. doi:10.1136/practneurol-2021-003007
14. Si M, Zhang XY, Yang RH, Wang XS, Zhang XX, Gao GS. Acute posterior circulation toxic encephalopathy following wasp sting: a case report on a novel syndrome.
15. J Neurol. 2022;269(8):4535-4538. doi:10.1007/s00415-022-11064-4
16. Li H, Wen J, Zhou JL, Chen B, Wu XR. Subarachnoid hemorrhage following wasp stings. Am J Emerg Med. 2023;68:215.e3-e7. doi:10.1016/j.ajem.2023.03.040
17. Zhang J, Zhou Y, Zhong Z, Liu X. Cerebral venous sinus thrombosis accompanied by cerebral venous infarction and multiorgan dysfunction after wasp stings, A case report. Heliyon. 2024;10(12):e32876. doi:10.1016/j.heliyon.2024.e32876
18. Kaur A, Gupta M, Ahuja I, Koul A. An unusual neurological complication of multiple wasp stings: AIDP. Apollo Med. 2024;21(1_suppl):S69-S71.
19. Tomic S, Zjalic M, Popovic Z, et al. Case report: Rapid-onset parkinsonism after a hornet sting. Front Neurol. 2024;15:1365199. doi:10.3389/fneur.2024.1365199
20. Thavara BD, Parambil RM, Jose BV, et al. A rare case of multiple wasp stings causing bilateral ischemic stroke. Iran J Neurosurg. 2025;11:E8. doi:10.32598/irjns.11.8
21. Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. doi:10.1016/j.waojou.2020.100472
22. Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-1123. doi:10.1016/j.jaci.2020.01.017
23. Muraro A, Worm M, Alviani C, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022;77(2):357-377. doi:10.1111/all.15032