A Case Report of Anaphylactic Shock Due to Hornet Sting with Multiple Organ Dysfunction Complications

Putu Saraswati Laksmi Dewi; I Ketut Suardamana

doi:10.3889/oamjms.2022.10487

Authors

Putu Saraswati Laksmi Dewi Department of Internal Medicine, Specialist Education Study Program, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia
I Ketut Suardamana Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.10487

Keywords:

Hornet-sting, Acute liver injury, Acute kidney injury, Disseminated intravascular coagulation

Abstract

BACKGROUND: Hornet venom has been recognized to induce lethal systemic effects such as anaphylaxis shock, bronchospasm, acute kidney or liver injury, disseminated intravascular coagulation (DIC), cardiovascular collapse, and even death. It consists of several enzymes and polypeptides with low molecular weights. It has been reported to contain the enzymes phospholipase A2, hyaluronidase, phosphomonoesterase acid ester, α-D-glucosidase, lysophospholipase, α-galactosidase, α-acetylamino-deoxsiglucosidase, and arylamidase. The venom will cause localized or systemic inflammation, an anticoagulant effect that may be fatal.

CASE REPORT: Herewith, a survival case report suffered from DIC with multi-organ failure following severe anaphylaxis shock post a hundred or massive Hornet sting.

CONCLUSION: We have reported a case of anaphylactic shock after a massive hornet sting with DIC that presented symptoms of shock, AKI, ALI, and multi-site bleeding. Although the mortality rate for similar cases is quite high, the outcome will be better with comprehensive and adequate treatment.

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References

Mingomataj EÇ, Bakiri AH, Ibranji A, Sturm GJ. Unusual reactions to hymenoptera stings: What should we keep in mind? Clin Rev Allergy Immunol. 2014;47(1):91-9. https://doi.org/10.1007/s12016-014-8434-y PMid:24962710 DOI: https://doi.org/10.1007/s12016-014-8434-y

Daher ED, da Silva Junior GB, Bezerra GP, Pontes LB, Martins AM, Guimarães JA. Acute renal failure after massive honeybee stings. Rev Inst Med Trop Sao Paulo. 2003;45(1):45-50. https://doi.org/10.1590/s0036-46652003000100010 PMid:12751323 DOI: https://doi.org/10.1590/S0036-46652003000100010

Smallheer BA. Bee and wasp stings: Reactions and anaphylaxis. Crit Care Nurs Clin North Am. 2013;25(2):151-64. https://doi.org/10.1016/j.ccell.2013.02.002 PMid:23692935 DOI: https://doi.org/10.1016/j.ccell.2013.02.002

Fitzgerald KT, Flood AA. Hymenoptera stings. Clin Tech Small Anim Pract. 2006;21(4):194-204. https://doi.org/10.1053/j.ctsap.2006.10.002 PMid:17265905 DOI: https://doi.org/10.1053/j.ctsap.2006.10.002

Sampson HA, Munnos-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: Summary report--second national institute of allergy and infectious disease/food allergy and anaphylaxis network symposium. J Allergy Clin Immunol. 2006;117(2):381-97. https://doi.org/10.1016/j.jaci.2005.12.1303 PMid:16461139 DOI: https://doi.org/10.1016/j.jaci.2005.12.1303

Pumphrey RS, Roberts IS. Postmortem findings after fatal anaphylactic reactions. J Clin Pathol. 2000;53(4):273-6. https://doi.org/10.1136/jcp.53.4.273 PMid:10823122 DOI: https://doi.org/10.1136/jcp.53.4.273

Johansson B, Eriksson A, Örnehult L. Human fatalities caused by wasp and bee stings in Sweden. Int J Legal Med. 1991;104(2):99-103. https://doi.org/10.1007/bf01626039 PMid:2054310 DOI: https://doi.org/10.1007/BF01626039

Zhang L, Tang Y, Liu F, Shi YY, Cao Y, Xu H, et al. Multiple organ dysfunction syndrome due to massive wasp stings: An autopsy case report. Chin Med J (Engl). 2012;125(11):2070-2. PMid:22884081

Klotz JH, Klotz SA, Pinnas JL. Animal bites and stings with anaphylactic potential. J Emerg Med. 2009;36(2):148-56. https://doi.org/10.1016/j.jemermed.2007.06.018 PMid:17997071 DOI: https://doi.org/10.1016/j.jemermed.2007.06.018

Tsai CL, Fang CC, Chen WJ, Dierberg K. Hornet sting-induced toxic hepatitis. Clin Toxicol (Phila). 2005;43(2):127-8. https://doi.org/10.1081/clt-200050386 PMid:15822768 DOI: https://doi.org/10.1081/CLT-200050386

Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, et al. Clinical features of severe wasp sting patients with dominantly toxic reaction: Analysis of 1091 cases. PLoS One. 2013;8(12):e83164. https://doi.org/10.1371/journal.pone.0083164 PMid:24391743 DOI: https://doi.org/10.1371/journal.pone.0083164

Kularatne K, Kannangare T, Jayasena A, Jayasekera A, Waduge R, Weerakoon K, et al. Fatal acute pulmonary oedema and acute renal failure following multiple wasp/hornet (Vespa affinis) stings in Sri Lanka: Two case reports. J Med Case Rep. 2014;8(1):188. https://doi.org/10.1186/1752-1947-8-188 DOI: https://doi.org/10.1186/1752-1947-8-188

van der Linden PW, Kerckhaert JA, van der Zwan JC, Hack CE, Struyvenberg A. Preliminary report: Complement activation in wasp-sting anaphylaxis. Lancet. 1990;336(8720):904-6. https://doi.org/10.1016/0140-6736(90)92272-j PMid:1976931 DOI: https://doi.org/10.1016/0140-6736(90)92272-J

Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: A critical and comprehensive review. Clin Kidney J. 2013;6(1):8-14. https://doi.org/10.1093/ckj/sfs160 PMid:27818745 DOI: https://doi.org/10.1093/ckj/sfs160

Han-Min W, Feng L, Mei-Lan Z, Rong L, Hong-Bao L, Chen H, et al. Successful treatment of multiple organ failure after wasp stings in an elderly patient. Int J Gerontol. 2012;6(1):52-3. https://doi.org/10.1016/j.ijge.2012.01.002 DOI: https://doi.org/10.1016/j.ijge.2012.01.002

Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of dissaeminated intravascular coagulation. British committee for standards in haematology. Br J Haematol. 2009;145:24-33. https://doi.org/10.1111/j.1365-2141.2009.07600.x PMid:19222477 DOI: https://doi.org/10.1111/j.1365-2141.2009.07600.x

Zolfagharian H, Mohajeri M, Babaie M. Honey bee venom (Apis mellifera) contains anticoagulation factors and increases the blood-clotting time. J pharmacopuncture. 2015;18(4):7-11. https://doi.org/10.3831/kpi.2015.18.031 PMid:26998384 DOI: https://doi.org/10.3831/KPI.2015.18.031

Jung JW, Jeon EJ, Kim JW, Choi JC, Shin JW, Kim JY, et al. A fatal case of intravascular coagulation after bee sting acupuncture. Allergy Asthma Immunol Res. 2012;4(2):107-9. https://doi.org/10.4168/aair.2012.4.2.107 PMid:22379607 DOI: https://doi.org/10.4168/aair.2012.4.2.107

Danapriya J, Dineshkumar T, Sakthirajan R, Shankar P, Gopalakhrisnan N, Balasubramaniyan T. Wasp sting--induced acute kidney injury. Clin Kidney J. 2016;2:201-4. https://doi.org/10.1093/ckj/sfw004 PMid:26985369 DOI: https://doi.org/10.1093/ckj/sfw004