Hemorrhagic syndrome and Acute renal failure in a pregnant woman after contact with Lonomia caterpillars: a case report

Abstract

A case of a 37-week pregnant woman who developed a hemorrhagic syndrome and acute renal failure after contact with Lonomia caterpillars is reported. The accident also initiated labour and the patient gave birth to an alive child. Some pathophysiological aspects of the genital bleeding and of the acute renal failure are discussed.

Acute Kidney Injury Induced by Snake and Arthropod Venoms

“…The impossibility of conducting early renal biopsies, due the coagulation disturbances inherent to the envenomation, has made it difficult to analyze the acute anatomopathological alterations. The few reports existing in the literature describe thickening of the Bowman's capsule, focal tubular atrophy and acute tubular necrosis (Burdmann et al, 1996;Fan et al, 1998) (Table 2). Similarly, the contribution of other factors possibly associated with AKI, such as hypotension or glomerular fibrin deposition, remains still obscure in Lonomia envenomation.…”

New Insight into the Mechanism of <i>Lonomia obliqua</i> Envenoming: Toxin Involvement and Molecular Approach

“…The symptoms usually begin with a burning pain on the contact area, followed by erythema, edema, heat and blisters [13,15] and systemic symptoms (headache, fever, nausea, emesis and malaise) [10,13] . Bleeding diathesis may occur a few hours after the accident, which consists of gengivorrhagia, ecchymosis and hematomas of variable intensity, bleeding from many sites (nose, gums, gut, genitourinary tract, and even from recent wounds), epistaxis, hematemesis or hematuria [10,13,15] . Hemolysis has been described in only two cases out of all envenomed patients in southern Brazil [16,21] .…”

“…Table 1 lists the hemostatic alterations in patients and experimental animals after envenoming by L. obliqua venom. The global coagulation tests, whole blood clotting time, prothrombin time, activated partial thromboplastin time and thrombin time are prolonged in most cases, and furthermore hypofibrinogenemia and normal or slightly low platelet count are observed [10,13,15] . Patients present low levels of fibrinogen, plasminogen, ␣ 2-antiplasmin prekallikrein, protein C activity, and factors V and XIII, whereas antithrombin, von Willebrand factor and protein S are not altered.…”

“…In 1989, an outbreak of accidents with hemorrhagic manifestations, occurring after the contact with caterpillars of L. obliqua , was registered in southern Brazil [12] . Since then, the number of accidents with humans has been increasing in the states of Rio Grande do Sul, Santa Catarina and Paraná [9,13,14] , and after that accidents were reported in the states of São Paulo [15] , Rio de Janeiro [16] and Minas Gerais [4] .…”

Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae): first report in the Zona da Mata Mineira region, Southeast Brazil

“…In the other hand, reports in the Southeast region are rarest when compared to the Southern records (Fan et al 1998;Malaque et al 2006). According to Jader (2007), in Minas Gerais State, the Departamento de Saúde has been alerting the population concerning the risks of accidents with caterpillars, since the state started to register accidents with this species since December 2002.…”