Pediatr Nephrol (2005) 20:550–551

DOI 10.1007/s00467-004-1685-8

LETTER TO THE EDITORS

Shadi Hasan · Kamal Hassan

Proteinuria associated with centipede bite

Published online: 15 December 2004

IPNA 2004

Sirs, centipede. Her mother brought the dead 5-inch centipede

Centipedes are arthropods of the class chilopoda. De-
pending on the species, centipedes can vary in length
from 1 to 12 or more inches when mature. Centipedes
vary in color from light yellow to dark brown. Centipedes
are found worldwide, in temperate and tropical areas,
including the Middle East and Mediterranean regions.
Centipedes are chiefly nocturnal, live in humid environ-
ments, are venomous invertebrates and have exoskeleton
and jointed legs. Centipede bites are benign common
accidents and usually present with local pain, edema, and
local hyperthermia [1]. The treatment includes analgesics
and local anesthesia to decrease pain. Although steroids
are still widely recommended in the literature to treat the
toxic effects of animal bites and stings, they have no
proven value. Steroids, antihistamines, and adrenaline are
used when hypersensitivity reactions are involved. With
centipede bites, however, it is not clear whether the local
effect is toxic or allergic. Rhabdomyolysis and acute renal
failure have been reported following the bite of the giant
desert centipede Scolopendra heros [2]. Pericoronitis due
to a centipede bite has also been described [3]. Proteinuria
after centipede bites has not been previously reported. We
report the first case of proteinuria developing after a
centipede bite.
A 15-year-old girl presented with mild local edema
and pain in her left wrist 2 h after she had been bitten by a
that obviously belonged to the class chilopoda (Scolo-
pendra species) that is common in the area.
She was treated with oral paracetamol 500 mg b.i.d.
Six days after the centipede bite, she still complained of
local swelling and pain in the same wrist. Physical ex-
amination revealed local edema and erythema of her left
wrist. The remaining physical examination was normal.
Blood analysis including renal function, electrolytes,
glucose, liver function, erythrocyte sedimentation rate,
complement, antinuclear antibodies, albumin, and glob-
ulin were within the normal range (creatinine 0.8 mg/dl,
albumin 4.2 g/dl). Urinalysis revealed specific gravity
1.025, protein 2+ without erythrocytes, leukocytes, or
casts, and a 24-h urinary protein of 1.7 g/1.73 m2 per day.
Abdominal ultrasonography showed normal kidneys. The
local edema and erythema of her left wrist resolved within
3 days. The 24-h urinary protein was measured weekly
(Fig. 1). The proteinuria increased to 2.8 g/1.73 m2 per
day at 3 weeks after the centipede bite, decreased spon-
taneously and gradually with time, and disappeared after

S. Hasan
Rappaport Faculty of Medicine,
Technion,
Haifa, Israel
K. Hassan ())
Peritoneal Dialysis Unit,
Western Galilee Hospital,
POB 21, Nahariya 22100, Israel
e-mail: drkamalh@hotmail.com
Tel.: +972-51-887913
K. Hassan
Clalit Health Services, Fig. 1 The 24-h urinary protein between 1 and 15 weeks after the
Haifa, Israel centipede bite

15 weeks. Therefore, a kidney biopsy was not performed.
Proteinuria was not detected during the following
10 months of follow-up. The patient’s renal functions
were normal.
Nephrotic syndrome has been previously reported after
bee or wasp stings and after ant, insect, or spider bites [4,
5, 6, 7, 8, 9, 10, 11, 12]. The period between the sting or
bite and the detection of proteinuria has ranged from
5 days to 3 weeks [4, 8, 9]. The clinical presentation of
most reported cases was nephrotic syndrome [4, 5, 6, 8, 9,
10]. Percutaneous kidney biopsies were performed in
some of the reported cases [6, 8, 9]. Although spontane-
ous remission might occur, corticosteroid treatment in-
duced prompt remission and shortened the duration of
hospitalization in some cases [4, 9]. Although the exact
mechanism was not investigated, the laboratory analysis
revealed glomerular proteinuria. Orthostatic and exercise
proteinuria were excluded. The patient had no history of
nephrological disorders or pre-existing proteinuria. The
incidence of proteinuria after different stings or bites is
not precisely known. Although most of the reported cases
presented as nephrotic syndrome [4, 5, 6, 8, 9, 10], we
assume that some cases of proteinuria were not detected
because they were asymptomatic, self-limited, and did not
necessitate medical attention. Therefore, we suggest that
repeated urinalysis after stings or bites may identify such
cases.
551
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