Clinical Chemistry - Case Study
Student Discussion Document (pdf)
Mark A. Cervinski, K. Aaron Geno, and Karen S. Hsu Blatman
An active 71-year-old male was referred to allergy and immunology for new-onset whole body urticarial rash. The patient had a prior ST elevation myocardial infarction approximately 6 years prior and has since had 2 separate stents placed: one was placed in his left main coronary artery at the time of his ST elevation myocardial infarction, and the second was placed approximately 3 years later in the left anterior descending artery, which had significant (95%) blockage. Despite his cardiac history, the patient maintained an active lifestyle, working as a construction worker and logger, and was an avid hunter. The patient reported that 3 months prior to his appointment with allergy and immunology, he developed a full-body urticarial rash approximately 4 hours after eating meals that included moose and venison.
Following these incidents, the patient abstained from red meat with no additional symptoms until 2 weeks prior to the appointment, at which time the patient had an urticarial rash following consumption of wild boar. His partner was concerned that the patient had an allergic response to soy (in the form of soy sauce) or an ingredient contained in Worcestershire sauce, both of which were used to season the game consumed in his meals.
As the patient spent a considerable amount of time in heavily forested areas and had experienced frequent tick bites, he was curious whether this reaction could be related to Lyme disease, for which he had previously been diagnosed and treated.