We report the case of a 9-year-old boy who presented to our outpatient dermatology clinic with a painful, itchy lesion on the dorsum of his right foot. Symptoms began approximately four hours before presentation, following an afternoon spent playing barefoot in a local park. According to the parents, the child suddenly complained of pain and itching, and they observed several small ants, identified as red ants, crawling nearby.

Clinical examination revealed a single edematous and erythematous lesion with poorly defined borders on the dorsum of the right foot (Figure). The area was warm to the touch, and the child reported moderate pruritus and discomfort. He showed no systemic symptoms such as fever, respiratory distress, or general malaise, and his medical history was unremarkable, with no known allergies or previous similar reactions.

Figure 1: Clinical image of the left foot in a 9-year-old male patient, showing localized swelling and mild erythema on the dorsum, consistent with an inflammatory reaction following a red ant bite.

Initial treatment consisted of gentle cleansing of the area, and administration of an oral antihistamine to relieve itching. The patient was closely monitored, and symptoms improved within 24 hours without complications. This case underscores a frequently encountered, yet often underestimated, dermatological issue during the warmer seasons, insect bites, particularly from red ants. Though typically self-limiting, these reactions can cause notable discomfort in children and may occasionally lead to more serious outcomes if left untreated.

The red imported fire ant (Solenopsis invicta), a species native to South America, has recently been identified in Europe, with a stable population documented in Sicily, Italy [1]. Its presence raises both ecological and public health concerns, given its aggressive nature and the potential severity of its

venom’s effects in humans.

Solenopsin, a major alkaloid in S. Invicta venom, exhibits diverse   biological activity [2,3]. It inhibits the PI3K/Akt signaling pathway, a mechanism vital for angiogenesis and cellular survival, and can also increase membrane permeability in mast cells [2,3]. This action promotes histamine release, triggering inflammatory responses and, in susceptible individuals, contributing to allergic reactions [2,3].

As outdoor activities become more common with the heat, it is vital to remain vigilant about skin protection and environmental hazards. Children, by virtue of their behavior and curiosity, are particularly vulnerable. Simple preventive measures-such as wearing appropriate footwear in grassy areas, using insect repellents, and checking the skin after outdoor play-can go a long way in reducing the risk of insect bites and their potential consequences.

1. Menchetti M, Schifani E, Alicata A, Cardador L, Sbrega E, Toro-Delgado E, et al. The invasive ant Solenopsis invicta is established in Europe. Current biology: CB. 2023; 33: R896-R897.
2. Arbiser JL, Kau T, Konar M, Narra K, Ramchandran R, Summers SA, et al. Solenopsin, the alkaloidal component of the fire ant (Solenopsis invicta), is a naturally occurring inhibitor of phosphatidylinositol-3-kinase signaling and angiogenesis. Blood. 2007; 109: 560-565.
3. Lind NK. Mechanism of action of fire ant (Solenopsis) venoms. I. Lytic release of histamine from mast cells. Toxicon off j Int Soc Tox. 1982; 20: 831-840.