Abstract
Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly >10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.
Highlights
The incidence of wasp sting globally is approximately 56% to 94%
Despite the number of cases, only one medical case report of wasp sting has been published from Indonesia
We present a case of multiple wasp stings leading to acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS) in a 9-year-old girl from Indonesia, who was admitted to the hospital 3 days after being stung
Summary
The incidence of wasp sting globally is approximately 56% to 94%. Wasp stings can result in various manifestations, from local reactions to life-threatening conditions [1]. Hidayati EL et al emergency room of the national referral hospital in Jakarta due to generalized swelling from 3 days before admission after she had been stung by a large number of wasps. She was walking in an unattended yard with a friend without noticing that a group of kids was disturbing a wasp nest on a tree. There were 93 lesions of wasp stings noted (Figure 1A–C), together with generalized swelling, prominent jaundice, and anuria She had a low-grade fever (37.8°C) and normal blood pressure (110/60 mm Hg). A follow-up clinic visit 12 weeks following the wasp stings showed negative results for albuminuria and a normal urinary albumin-to-creatinine ratio (29 mg/g)
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