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Acute peripheral neuropathy following animal envenomation: A case report and systematic review

  • Stéphane Mathis
    Correspondence
    Corresponding author at: Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France.
    Affiliations
    Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France

    ALS Center, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France

    AOC Neuromuscular Reference Center, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France
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  • Louis Carla
    Affiliations
    Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France
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  • Fanny Duval
    Affiliations
    Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France

    AOC Neuromuscular Reference Center, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France
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  • Louis Nadal
    Affiliations
    Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France
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  • Guilhem Solé
    Affiliations
    Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France

    AOC Neuromuscular Reference Center, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France
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  • Gwendal Le Masson
    Affiliations
    Department of Neurology, Nerve-Muscle Unit, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France

    ALS Center, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France

    AOC Neuromuscular Reference Center, University Hospital (CHU) of Bordeaux (Pellegrin Hospital), 2 place Amélie Raba-Léon, 33000 Bordeaux, France
    Search for articles by this author
Published:October 10, 2022DOI:https://doi.org/10.1016/j.jns.2022.120448

      Highlights

      • Animal envenomation is a rare cause of acute peripheral neuritis.
      • This phenomenon may lead to either mononeuropathy (multiplex or not) or polyneuritis.
      • Mononeuropathies may be due to some direct toxic reactions and/or vasculitis processes of some components of the venom.
      • Polyneuropathy could be due to an allergy-triggered immune-mediated reaction.
      • The prognosis of such peripheral neuropathies is usually favorable.

      Abstract

      Animal envenomation in humans is usually accidental or for defensive purposes. Depending on the venom composition and administration, different reactions can be observed. After reporting the first case of acute polyradiculitis in a 57-year-old healthy male after red lionfish envenomation, we propose to analyze rare similar cases of acute neuritis after animal envenomation published in the medical literature. Including our case, we found 54 patients who developed acute peripheral neuropathy after having been stung or bitten by various animals, mainly hymenoptera (in half of the cases) but also jellyfishes, snakes, corals or nonhooked arthropods. We observed two distinct patterns of peripheral neuropathy: more than half of them were polyneuropathy while the others were focal neuropathy. The prognosis was favorable in most cases. The pathophysiological mechanism associated with these rare complications remain unknown, although some hypotheses may be proposed. A direct action of certain components of the venom, such as phospholipase-A2, could explain the focal forms of peripheral neuropathy trough toxic reactions and/or vasculitis processes. The more diffuse clinical situations could be due to an allergy-triggered immune-mediated reaction (possibly linked to a molecular mimicry mechanism between venom proteins and some myelin proteins of the peripheral nervous system), or to the action of some venom components on membrane ionic channels particularly at the node of Ranvier. Even if acute peripheral neuropathies are rare after envenomation, they may occur after envenomation from various animals, and their usually favorable prognoses should be known by neurologists.

      Keywords

      Abbreviations:

      CMAP (compound muscle action potential), CMV (cytomegalovirus), CNS (central nervous system), CSF (cerebrospinal fluid), EBV (Epstein–Barr virus), EMG (electromyography), GBS (Guillain-Barré syndrome), HIV (human immunodeficiency virus), HSV (herpes simplex virus), IgE (immunoglobulin-E), IgIV (intravenous ilmmunoglobulin), MRI (magnetic resonance imaging), NCS (nerve conduction studies), NCV (nerve conduction velocity), P (patient;), LA2 (phospholipase-A2), PLEX (plasma exchange), PNS (peripheral nervous system), SNAP (sensory nerve action potential), VIT (venom immunotherapy), VZV (varicella zoster virus)
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