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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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More Bee Story

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Jeremy Joslin, MD has left a new comment on your post "Question About a Bee Sting":

"Thanks for posting this very interesting case. Your blog really helps me learn through cases that I don't ordinarily see.

Dr. Auerbach, do you think this could be a Type 4 hypersensitivity reaction alone which is causing the drawn-out symptoms? Like you said, the inflammatory mediators alone could be causing all of these symptoms simply by mere proximity to all the fine hand structures.

While special ultrasonography would be a useful first line modality, if it's not available do you think MRI would be able to define the "knot" and give a hint as to which soft-tissue structure it is associated with?

To me it doesn't seem very likely that such a minute penetration of the skin could violate the nerve sheath."

These are terrific questions. It is possible that this might be a prolonged hypersensitivity reaction, but I have not been made aware of a type 4 hypersensitivity reaction associated with a bee sting. I have, however, seen a reaction that was quite similar to serum sickness associated with multiple stings afflicting a single victim.

Magnetic resonance imaging (MRI) might be useful to define a foreign body, but I am not aware of its use for a bee stinger. The stinger would have to have penetrated quite deeply to warrant this modality, and in my experience, a retained stinger leaves a trailing end at the surface.

Violating a "nerve sheath" would not be the problem here, but rather a "reactive" inflammatory response affecting the nerve or a tendon sheath. It is not uncommon to have the introduction of an animal or plant toxin in the vicinity of a tendon, and to have it become inflamed.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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