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All Journal Open Access Indonesian Journal of Medical Reviews Archives of The Medicine and Case Reports
I Made Eryana
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Health Professions Medicine & Pharmacology Nursing Public Health

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Intensive Care Management of Anaphylactic Shock Secondary to Wasp Stings: A Case Report I Made Eryana; Ni Luh Putu Winda Alpiniawati; Dewa Ayu Rina Wana; I Gede Putu Jarwa Antara
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 6 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i6.683

Abstract

Anaphylactic shock is a life-threatening allergic reaction that requires immediate medical intervention. Wasp stings are a common trigger for anaphylaxis, and rapid administration of epinephrine is crucial in preventing fatal outcomes. This case report describes the successful intensive care management of a patient who developed anaphylactic shock following multiple wasp stings. A 51-year-old female presented to the emergency department with anaphylactic shock after being stung by multiple wasps. She exhibited severe angioedema, hypotension, and tachycardia. Immediate treatment included intramuscular epinephrine, intravenous corticosteroids, antihistamines, and fluid resuscitation. The patient was transferred to the intensive care unit (ICU) for close monitoring and supportive care. In conclusion, this case highlights the importance of prompt recognition and treatment of anaphylactic shock, particularly the administration of epinephrine. It also emphasizes the role of ICU monitoring in managing severe allergic reactions and preventing complications.
Cerebral Toxoplasmosis with Preserved CD4 Count (>300 cells/µL) in the HAART Era: Unmasking Immune Reconstitution Inflammatory Syndrome and the Diagnostic Utility of Cotrimoxazole I Made Eryana; Made Nopriantha
Archives of The Medicine and Case Reports Vol. 6 No. 4 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i4.830

Abstract

Cerebral toxoplasmosis (TE) typically presents in HIV-positive patients with severe immunosuppression (CD4 <100 cells/µL). However, in the era of Highly Active Antiretroviral Therapy (HAART), presentations have become atypical. We report a rare case of TE in a patient with a preserved CD4 count (>300 cells/µL), highlighting the phenomenon of unmasking immune reconstitution inflammatory syndrome (IRIS). A 22-year-old female, HIV-positive on a Tenofovir-Lamivudine-Efavirenz (TLE) regimen for one month, presented with subacute hemicrania, focal motor seizures, and complex visual hallucinations (zoopsia). Despite a CD4 count of 307 cells/µL and a suppressed viral load (<40 copies/mL), Contrast-Enhanced Computerized Tomography (CE-CT) revealed multiple ring-enhancing lesions with significant perilesional edema. The patient was diagnosed with TE-associated Unmasking IRIS. Due to the unavailability of Pyrimethamine, she was treated with high-dose Cotrimoxazole (960 mg q6h). Significant clinical improvement was observed by day 4, characterized by the cessation of seizures and hallucinations. Follow-up at two weeks confirmed sustained neurological recovery. In conclusion, a preserved CD4 count does not exclude opportunistic infections in the early post-HAART period. This case underscores the diagnostic pitfall of immune discordance and validates the efficacy of Cotrimoxazole as a primary therapeutic intervention in resource-limited settings.
Co-Authors Dewa Ayu Rina Wana I Gede Putu Jarwa Antara Made Nopriantha Ni Luh Putu Winda Alpiniawati