Multiple cerebral infarctions with severe multi-organ dysfunction following multiple wasp stings
A 40-year-old male, normotensive, non-diabetic, reported was stung by 50-60 wasps all over the body including face, head, and neck region. He was complaining of redness, swelling, and pain all over the body. He was treated at peripheral hospital with chlorpheneramine and Hydrocortisone injection. He remained stable for next 16-18 h, after which he developed rapid progressive deterioration in consciousness and became unresponsive within a period of next 4-6 h with associated history of vomiting and incontinence of urine. There was no history of headache, fever, breathlessness, trauma, abnormal body movement, drug intake, bleeding from any site, and jaundice. He was then brought to our emergency, where his initial assessment showed Glasgow Coma Scale of 6/15 with Blood Pressure of 170/100 mmHg. He was febrile to touch, multiple wasp sting marks [] with swelling of right upper limb (a total of 73 sting marks), moving left side of body on deep painful stimuli, gaze preference towards left side and with bilateral extensor response.\nA provisional diagnosis of stroke after multiple wasp sting was made, baseline laboratory investigation [] (complete blood count, renal and liver function tests, arterial blood gas analysis, electrocardiograph, x-ray chest, blood glucose, electrolytes, urine examination, Creatine Phosphokinase/Lactate Dehydrogenase, and coagulogram) were sent along with Non contrast Computed Tomography of head and was started on i.v hydrocortisone, i.v avil, and i.v antibiotics along with supportive measures.\nNon contrast Computed Tomogarphy of head was suggestive of hypodense areas in left thalamic region and occipital area. Later, further investigation like Fibrin degradation product, D-Dimer, and C-reactive protein was done which were also positive and next day magnetic resonance imaging of brain with diffusion weighted images was performed which revealed multiple hyperintense lesions in cortical and subcortical areas with loss of grey white contrast in both cerebral hemispheres, pons bilateral thalami, and left parieto-occipital region with evidence of marked diffusion restriction [].\nHis ultrasound abdomen, X-ray chest, electrocardiograph, electrolytes, arterial blood gases, liver function tests, urine examination was normal and antinuclear antibody, anti-double stranded DNA was negative.\nAfter 4 days, his NCCT head was repeated which showed hypodensities in left thalamic, left parieto-occipital, bilateral cerebellar hemispheres, and in pontine region.\nDuring the hospital stay of 23 days, he remained hemodynamically stable but his clinical condition did not improve much and was finally discharged in a vegetative state with GCS of 5/15 on oral steroids and antibiotics.