Abstract
Wasp and bee stings are common among the rural population of Sri Lanka. It is known to cause local reaction and rarely anaphylaxis. Bee sting associated rhabdomyolysis leading to acute kidney injury (AKI) is a rare complication and was not reported from Northern Sri Lanka. This case report illustrates a patient who developed rhabdomyolysis following multiple bee stings and made a complete clinical recovery with prompt and optimal supportive care.
Highlights
Apis dorsata or the “rock bee” (Figure 1) of the order Hymenoptera, is found in South and SouthEast asia
In addition to Acute Kidney Injury (AKI) it can result in electrolyte abnormalities, hypoalbuminemia, hyperuricemia and disseminated intravascular coagulation (DIC)
Basic laboratory investigations revealed elevated aspartate aminotransferase(AST) from 921U/l to 1587 U/l (16-63) and serum creatinine 87μmol/l to 117μmol/l raising the possibility of an ongoing rhabdomyolysis and was subsequently confirmed by a creatinine phosphokinase(CPK) level of 40,110U/l
Summary
Apis dorsata or the “rock bee” (Figure 1) of the order Hymenoptera, is found in South and SouthEast asia. They are known for their aggressive behavior and defense strategies (1). Usual stings are accidental following the unintentional intrusion of the area around the beehive or the nest by the victim (2). Nephritis as an effect of myoglobin released into the circulation following skeletal muscle injury (4). In addition to Acute Kidney Injury (AKI) it can result in electrolyte abnormalities, hypoalbuminemia, hyperuricemia and disseminated intravascular coagulation (DIC). The common causes include trauma, compartment syndrome, status epilepticus and muscle toxins such as statins, antimalarial medications and snake and insect venom (4)
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