Rationale: Acquired neuromyotonia syndrome is a rare form of peripheral nerve hyperexcitability syndrome. It is characterized by spontaneous and continuous muscle contractions. Acquired neuromyotonia syndrome is mainly observed in patients with autoimmune diseases or tumors, but it is a rare neurological clinical manifestation in patients with mercury poisoning. Patient concerns: A 56-year-old woman presented with continuous and involuntary muscle twitching in her legs for 2 months; it was accompanied by a burning sensation in the lower limbs, insomnia, fatigue, and night sweats. These symptoms did not disappear during sleep. Diagnoses: Toxicological blood analysis via atomic fluorescence spectrometry revealed that the level of mercury was 0.07 μmol/L (normal level: <0.05 μmol/L). Her urinary mercury level measured using the cold atomic absorption method was 217.50 μmol/mol creatinine, which was considerably higher than the reference range (0–2.25 μmol/mol creatinine for people not in contact with mercury, 0–20 μmol/mol creatinine following long-term exposure). Upon further testing, a high level of mercury (10,572 mg/kg) was detected in the patient's cream. Accordingly, this patient was diagnosed with mercury poisoning. Interventions: Treatment with 2,3-dimercapto-1-propanesulfonic acid (DMPS) was initiated. Her urinary mercury level decreased to 9.67 μmol/mol creatinine, and her neuromyotonia syndrome and hyponatremia were relieved, with urine protein completely disappearing after 3 months of treatment. Outcomes: After DMPS treatment, the clinical manifestations of the nervous system disappeared and electrolyte parameters returned to normal levels. Lessons: Acquired neuromyotonia syndrome is a rare disorder caused by the hyperexcitability of peripheral nerves, resulting in spontaneous and continuous muscle contraction. Mercury poisoning should be considered in patients with neuromyotonia syndrome. Early detection of mercury poisoning can prevent unnecessary examinations and treatments.

Background: We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes.Methods: From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally.Results: The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001).Conclusions: PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.

Background: Wasp sting is common in the world, and gross hematuria after wasp sting has been reported in Asia to occur before AKI. Gross hematuria is often used by clinicians as a sign indicated for intensive care and blood purification treatment. However, there is no study on the clinical characteristics and prognosis of wasp sting patients complicated with gross hematuria. Methods: The demographic characteristics and clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score was used as the criterion for severity classification. According to the presence of gross hematuria, the patients were divided into gross hematuria group and non-gross hematuria group. Multivariate logistic regression analysis was performed to explore the risk factors for gross hematuria.Results: Of the 363 wasp sting patients, 219 were male and 144 were female, mean age was 55.9±16.3 years. 51 (14%) had gross hematuria, 39(10.7%) had Acute Kidney Injury(AKI), 105 (28.9%) had rhabdomyolysis, 61(16.8%) had hemolysis, 56 (15.4%) had Multiple Organ Dysfunction Syndrome (MODS), 13 (3.6%) had Acute Respiratory Distress Syndrome (ARDS), 45(12.4%) went on to receive renal replacement therapy, and 14 (3.9%) died. Patients with gross hematuria group had significantly higher poisoning severity scores when admitted to the hospital than those without gross hematuria group (2.2±0.5 vs. 1.1±0.3, P<0.001).Conclusion: Gross hematuria is one of the early clinical symptoms of severe wasp sting patients. AKI incidence and mortality of patients with gross hematuria are significantly increased. Prompt treatment should be taken for wasp sting patients complicated with gross hematuria. The poisoning severity score can be used for early assessment of the severity of wasp sting patients.