Complicated Skin and Soft Tissue Infection Following Insect Sting

Case at a Glance

A 29-year-old male presented with a rapidly progressing skin and soft tissue infection following an insect sting, which developed into systemic sepsis with secondary lesions.

Patient's Story

The patient reported being stung by an insect (initially thought to be a bee) approximately one week prior to presentation. He maintained a healthy lifestyle with a balanced diet, adequate hydration (3 liters daily), and took no regular medications or supplements. Despite visible deterioration of the wound site over several days, the patient initially declined medical evaluation, believing the condition would resolve spontaneously.

Initial Assessment

Upon delayed presentation, the patient exhibited a large, necrotic wound with central ulceration at the original sting site on his upper extremity. The lesion measured approximately 4-5 cm in diameter with surrounding erythema and induration. The patient appeared unwell with pallor and diaphoresis noted by companions.

The Diagnostic Journey

During the medical evaluation, a secondary lesion was discovered on the patient's left foot - a raised, erythematous nodule measuring 2 cm in diameter by 1 cm in height, suggesting hematogenous spread. Vital signs revealed tachycardia with heart rate averaging 150 bpm, fever, and chills. Laboratory studies and blood cultures were obtained to identify the causative organism and assess for systemic involvement.

Final Diagnosis

Complicated skin and soft tissue infection with bacteremia/sepsis, likely secondary to bacterial superinfection following insect envenomation. The presence of distant secondary lesions confirmed hematogenous dissemination.

Treatment Plan

The patient was admitted for inpatient management with broad-spectrum intravenous antibiotics pending culture results. Supportive care included IV fluids for hydration and medications to control tachycardia and fever. The treatment plan included wound care with possible surgical debridement if indicated. Antibiotic therapy would be adjusted based on culture and sensitivity results.

Outcome and Follow-up

The patient required a minimum 3-day hospital stay for IV antibiotic therapy and monitoring. Medical staff emphasized that delayed treatment could have resulted in limb loss or life-threatening complications. The case highlighted the importance of seeking prompt medical attention for unusual reactions to insect stings, particularly when signs of secondary bacterial infection develop.