Severe Acute Kidney Injury after Multiple Honey Bee Stings

Sathi S, Garg AK, Chand J, Singh MK, Saini VS, Trivedi A
2020 International Journal of Nephrology and Kidney Failure  
Volume 6 -Issue 2 eicosanoids. There is systemic vasodilation and increased vascular permeability that leads to an increase uptake of venom by the blood vessels, which quickly spreads and decreases renal perfusion causing ischemic renal injury. Apamin is a peptide that acts as a neurotoxin causing degranulation of mast cells. Histamine is mostly the culprit damaging the vascular endothelium, as it can cause lysis of leukocytes, red blood cells and platelets. It has also been described that the
more » ... described that the direct toxic effect of the venom on skeletal muscles can cause rhabdomyolysis and myocardial necrosis [6] . The resultant anaphylaxis can cause shock and systemic vasodilation leading to hypoperfusion of many vital organs, including the kidneys. Anatomically, sting is the part of the female bee abdomen situated posteriorly, meant for egg lying (ovipositor) [9]. Bees use it as selfdefence when the victim's tissue is injected with the venom via the sting. After injecting the venom, sting is left at the site of inoculation by the bee [9]. Case Report A 47-year-old male patient presented with a two day history of swelling of whole body with facial puffiness after multiple honeybee stings, passage of cola colour urine, decreased urine output and altered sensorium without any history of blunt trauma, fever, sore throat, impetigo, joint pain, smoking or alcohol drinking, There was no any history of NSAID abuse, type 2 diabetes mellitus or hypertension. On admission the patient had an altered sensorium, dyspneic, and a pulse rate of 112/minute. His blood pressure was Abstract There is insufficient data for honey bee sting-induced severe acute kidney injury (AKI) in the world population. A single sting can cause allergic reaction, but severity of prognosis is directly proportional to the number of stings. Mellitin is the principal part of honey bee venom. It is associated with phospholipase A2 (PLA2) and has vasoactive and hemolytic properties. Severe AKI may occur after a massive honey bee attack (more than one thousand stings) and this is because of multitude of factors, including direct toxicity of venom to the kidney tubules, hypotension, dehydration, rhabdomyolysis and intravascular hemolysis. Here, we report a 47-year-old male patient who presented with passage of cola colour urine and advanced azotemia after a multiple honey bee injury. Additional analyses revealed very high serum creatine phosphokinase, serum lactate dehydrogenase and urine myoglobin levels. The patient was treated with antihistamines, hydrocortisone, fluid infusion and hemodialysis. Renal failure recovered completely and the patient was discharged in a stable condition.
doi:10.16966/2380-5498.195 fatcat:hyhs2edqqvb7nmidlhjz27inri