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The deep tendon reflexes as well as sensory and total leukocyte count of 8440/mm3. His liver
neurological examination was normal. Rest of the function, kidney function, thyroid function and other
systemic examination was also unremarkable in this biochemical parameters were well within normal
case. Investigations revealed hemoglobin of 136 g/L limits.
*
Maulana Azad Medical College, New Delhi.
Correspondence to: Dr Naresh Kumar, 16/554, Joshi Road, Karol Bagh, New Delhi-110005. E-mail Id: drnareshmamc@gmail.com
Urine examination was normal. Repetitive nerve His ptosis started improving within 48 hours while he
stimulation test did not show any decremental was staying in the ward. Swelling and stiffness of
response. pinna also subsided. Patient was discharged in an
asymptomatic condition on the 7th day of admission
Patient was treated with injection Chlorpheniramine (Fig. 2). The patient did not develop any episode of
and Hydrocortisone. He was kept on close follow up. ptosis in follow up of 6 months.
Figure 2.Clinical photograph of the patient on the 5th day of admission showing recovery of ptosis
ISSN: 2349-7181 2
J. Adv. Res. Med. 2015; 2(4) Singh H et al.
ptosis with wasp sting was first reported from India in References
2003.1 In this case, ptosis was associated with other
neurological manifestation suggestive of cranial nerve 1. Singh RD, Bhagat A, Pandey AK. Bilateral Ptosis
involvement. The patient was treated with following wasp sting. J Assoc Physicians India
neostigmine. The use of neostigmine in that case 2003; 51: 828-29.
followed by recovery also supported the hypothesis of 2. Pollack RJ, Norton SA. Ectoparasite Infestations
neuromuscular junctional blockade.7 and Arthropod Injuries. Harrison’s principles of
Internal Medicine. 19th Edn. McGraw-Hill
A 2-year-old girl presented with bilateral ptosis, the Professional, 2015: 2749-50.
sole neurological manifestation along with the local 3. Dobbs MR. Neurotoxic animal poison and
symptoms. She was managed with oral venoms. Clinical Neurotoxicology 2009: 471-72.
pyridostigmine and was left with only mild ptosis of 4. Mondal N, Krishnamurthy S, Narayanan P et al.
right eye on 8 weeks of follow up.4 However, our case Bilateral ptosis in a child following massive attack
presented with only bilateral ptosis along with the by a swarm of wasps. Journal of Child Neurology
local symptoms and was not treated with neostigmine 2011; 26(10): 1322-24.
or pyridostigmine. All the symptoms including ptosis 5. Brumlik J. Myasthenia gravis associated with wasp
improved completely within a week. The sting. JAMA 1976; 235: 2120-21.
improvement in our case without use of neostigmine 6. Hira HS, Mittal A, Kumar AS et al. Myasthenia
may be explained by the lesser amount of toxin in the gravis and acute respiratory muscle paralysis
bite. The present case can well be the first case of following wasp sting. Indian J Chest Dis Allied Sci
wasp bite-induced ptosis with spontaneous recovery 2005; 47: 197-98.
without use of neostigmine or pyridostigmine. 7. Ewan PW. Venom allergy. BMJ May 1998;
316(7141): 1365-68.
Conflict of Interest: Nil
3 ISSN: 2349-7181