Abstract
BackgroundHornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock. Rarely it can be following development of acute tubulo-interstitial nephritis.Case presentationWe describe a young male, who was stung on face, head, shoulders and upper limbs by multiple hornets (Vespa orientalis). He developed acute renal failure as a result of acute tubulo-interstitial nephritis and responded to steroids.ConclusionRare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings. Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal function
Highlights
Hornet stings are generally associated with local and occasionally anaphylactic reactions
Rare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings
Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal function
Summary
Insect stings are only followed by allergic reactions but sometimes intravascular hemolysis, rhabdomyolysis, thrombocytopenia [9], acute tubular necrosis, acute hepatic injury[10,11], and myocardial infarction [12] have been reported. Their venom is a concentrated mixtures of complicated active components, such as melittin, apamine, phospholipases, hyaluronidase, acid phosphatase, histamine, and kinin. There were reports of renal failure without any evidence of hemolysis and shock earlier but as renal biopsy was not done, the cause could not be ascertained and it was postulated to be due to the direct toxic effect of the venom [14]. It was postulated by them that, as these patients have other allergic manifestations like serum sickness-like reaction, delayed skin eruption, and possible vasculitis and as many components of the insect venom are polypeptides so theoretically, these allergens can mediate various types of renal injuries, such as immune complex-mediated glomerulonephritis, interstitial nephritis, renal microangiitis, or vasculitis
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