Dermoscopy as an auxiliary method in the diagnosis of social wasp (Hymenoptera, Vespidae) stings.

We describe the case of a 32-year-old male patient that sought medical treatment complaining of severe pain in his second and third right-hand fingers. The symptoms had started two hours before. The hypotheses of spider bite, scorpion or insect sting and injury caused by a foreign body were considered in the differential diagnoses. On dermoscopy, two foreign bodies were identified on his skin. After extraction, we concluded that they were wasp stingers.

Male patient, 32 years old, sought treatment in the emergency ward complaining of pain in his second and third right-hand fingers. While handling a stack of bricks - two hours before seeking medical treatment - he felt a stinging pain in his second righthand finger. On dermatological examination, edema of the second finger, metacarpophalangeal region, and the proximal phalanx of his third right-hand finger (Figures 1A and 1B) was observed. The hypotheses of spider bite, scorpion or insect sting and injury caused by foreign bodies were considered. Dermoscopy showed the presence of two brownish foreign bodies in his skin (Figures 1C and 1D). They were extracted and identified as two stingers measuring approximately 2mm each (Figure 2). The patient was advised to avoid moving his hand, apply ice to the affected area and use oral non-steroidal anti-inflammatory drugs. One hour after the stingers had been removed, he returned to the emergency ward bringing a wasp he had found at the site (Figure 3).

FIGURE 1

A - Edema in the patient’s second and third right-hand fingers; B - Metacarpophalangeal region showing edema; arrow and circle indicate the area where the stingers were inserted; C,D - Dermoscopy revealing the two stingers

FIGURE 2

A,B and C - Two stingers measuring approximately 2 mm are seen on dermoscopy; (D) After removal of the stingers, the affected area is seen in detail

FIGURE 3

A,B - Dorsal view of the insect collected by the patient; C - lateral view (D) Stingers removed from the patient’s skin

Hornets and wasps are insects that belong to the Hymenoptera order. Only the female has a stinger, since it is a modification of the ovipositor.[1] These insects' stings are painful and cause a burning sensation. In more sensitive individuals, they may cause an anaphylactic reaction, jeopardizing the performance of routine activities.[2-6]