Acute Kidney Injury Following Rhabdomyolysis due to Multiple Wasp Stings (Vespa affinis)

Abstract

Background: Wasp stings are quite commonly observed in Bangladesh though they are under reported. However, rhabdomyolysis following multiple wasp stings is a rare entity. Case report: A middle aged physician was stung by a swarm of wasps at multiple sites of the body. He felt severe pain at the sites of the stings and was primarily treated with intravenous hydrocortisone and chlorpheniramine. Within few hours he developed oliguria with dark color. The dipstick urine test was positive for myoglobin and negative for red blood cell. His serum creatinine was 1.65 mg/dl, and creatine phosphokinase was 3963 IU/L, on admission. Subsequently, creatinine increased for the next three days. He was given forced diuresis with furosemide for three days and other supportive treatments. Clinical and biochemical picture started to improve including urine output and color and normalized on 6th day post-admission. The species Vespa affinis was confirmed by a zoologist as the offending insect. Discussion: Wasp sting usually results in pain and allergic reactions, though severe anaphylaxis may occasionally occur. Mass envenomation can cause systemic reactions and organ dysfunction including rhabdomyolysis, hemolysis, coagulopathy, and hepatic, renal, cardiac and neurological complications. Rhabdomyolysis is a distinguished cause of acute kidney injury in patients with wasp sting. Vespa affinis is the species commonly found in this region which can bring catastrophe. Conclusion: Multiple wasp stings may cause rhabdomyolysis followed by renal failure. Immediate supportive treatment (including copious hydration and sodium bicarbonate) is the mainstay to reduce morbidity and mortality in such cases. How to cite this article: Chowdhury FR, Bari MS, Shafi AM, Ruhan AM, Hossain ME, Chowdhury S, et al. Acute Kidney Injury Following Rhabdomyolysis due to Multiple Wasp Stings (Vespa affinis). Asia Pac J Med Toxicol 2014;3:41-3.