Acute Bullous Skin Reactions After Imported Fire Ant Envenomation

Dermal reactions to imported fire ant (IFA) stings have been extensively investigated and characterized. We present an unusual case of bullous scarring lesions that, to our knowledge, has not been previously reported in the literature. The patient is a 5-year-old male who presented after developing significant scarring reactions to fire ant stings on two separate occasions. He did not have any other symptoms associated with the stings. The history and physical examination did not support the differential diagnoses of infection, underlying skin disease, or systemic disease that would predispose this patient to such an exaggerated and atypical response. Photographs of the acute response after two temporally isolated imported fire ant stings revealed dramatic bullae formation within 24 hours. Follow-up physical examination was remarkable for significant scarring of the skin without evidence of infection at the location of the stings. Further evaluation included an unremarkable past medical history, normal complete blood cell count and erythrocyte sedimentation rate, and negative human immunodeficiency virus testing. Skin-prick testing was positive to imported fire ant whole-body extract with appropriate controls. There was no evidence of bullae after skin-prick testing. Permission for publication of this case and photographs was obtained from the parent of the patient. This case represents an unusual response to imported fire ant envenomation associated with immunoglobulin E (IgE)-mediated sensitization. (Pediatr Asthma Allergy Immunol 2006; 19[1]:31–35.)