A Rare Presentation of Pancreatic Panniculitis-like Reaction After a Wasp Sting.

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Localized skin necrosis after bee and wasp stings is an exceptionally rare phenomenon, with few reported cases documented in the literature. Hymenoptera stings, including those from wasps, bees, and stinging ants, are common worldwide and typically result in localized reactions such as pain, erythema, and swelling. Although systemic complications, including anaphylaxis and multiorgan damage, are well recognized, localized skin necrosis remains poorly understood. In this study, we present a rare case of localized dermal necrosis in a 75-year-old woman with no systemic involvement after a yellow jacket sting. Notably, histopathologic examination revealed a lobal panniculitis with fat saponification with calcium deposition and ghost adipocytes-findings strikingly similar to pancreatic panniculitis. No infectious organisms or retained arthropod parts were identified. Wasp venom components include enzymes, proteins, and amines that cause type I hypersensitivity reactions and cause direct toxin-mediated tissue damage, yet the direct mechanism behind cutaneous damage is not well understood. This case represents the first reported instance of a pancreatic panniculitis-like reaction after a wasp sting, and contributes to the limited literature on wasp venom-induced skin necrosis.