Patient Develops Psoriatic Arthritis After Multiple Wasp Stings

While Hymenoptera stings have been previously associated with cases of beekeeper’s arthritis (arthritis that closely mimics osteoarthritis), there have been no documented reports of a link between Hymenoptera venom and the development of psoriatic arthritis. This case, published in the journal Annals of Allergy, Asthma, and Immunology, reports on a patient who developed psoriatic arthritis shortly after being stung multiple times by wasps. 

The patient, a 46-year-old man, presented to the hospital with asymmetric pain in multiple joints which began 10–12 days after he was stung by multiple wasps (6–8 stings). He had tried several medications to relieve the pain (acetaminophen, tramadol, meloxicam), but these agents did not improve his symptoms, and eventually the joint pain was severe enough for him to become wheelchair bound. Apart from psoriasis, he had no other medical, social, or family history that could be attributed to his symptoms.  Physical and laboratory examination revealed the following:

• Blood pressure: 128/72mmHg
• Pulse: 90/min
• Respiratory rate: 20/min
• Oral temperature: 37.2 °C
• Bilateral shoulder, left knee, right wrist swelling (warm and tender to palpitation)
• Erythrocyte sedimentation rate: 74mm/h (range: <17mm/h for males)
• C-reactive protein: 24mg/L (range: <1mg/L)
• Rheumatoid factor: 15 IU/mL (range: <15 IU/mL)
• Antinuclear antibody, anti-double-stranded DNA, HLA-B27, anticyclic citrullinated peptide, CBC, metabolic panel, serum protein electophoresis: all negative
• Aspiration of fluid from affected joints: unsuccessful
• Radiography of joints: normal