Combination of Multiple Organ Dysfunction and Anaphylaxis in a Case of Mass Wasp Envenomation: A Case Report

Abstract

Bees, wasps and ants are the common insects to sting. Fatalities due to wasp sting are uncommon. The wasp venom contains various biologically active compounds like histamine, phospholipase, hyaluronidase, adrenaline and noradrenaline. Various factors predispose the outcome of envenomation. Usually within 48 hours the victim recovers but when there is massive envenomation, serious complications like rhabdomyolysis, acute renal failure and anaphylaxis may develop. An elderly female was stung by a swarm of wasps. She presented to hospital with hypotension, stridor and swelling of the face. Biochemical investigations indicated azotemia. The creatinine kinase and immunoglobulin E level had increased twenty and 14 folds respectively. Histopathology report revealed acute tubular necrosis with red blood cell casts and eosinophilic infiltrates in the kidney, edema and intra alveolar hemorrhage in the lungs. Within 30 hours of the incident, the victim succumbed to the complications of the venom. Death in wasp envenomation may be due to anaphylaxis or multiple organ dysfunction. It is difficult to delineate the exact mechanism of death due to massive envenomation. The present case had a combination of multiple organ dysfunction and anaphylaxis.