Multi-organ dysfunction secondary to severe wasp envenomation

Abraham M Ittyachen, Shanavas Abdulla, Rifzana Fathima Anwarsha, Bhavya S Kumar

Wasp sting is not an uncommon incident. Around 56% to 94% of the population is stung at least once in their lifetime by a member of the order Hymenoptera which includes wasps, bees, and ants. The response to a wasp sting may vary from mild local reaction to severe systemic and anaphylactic reactions. The clinical picture and mortality rate tend to be more severe in adults compared to children. We present a 32-year-old agricultural worker who was bitten by multiple wasps while on a coconut tree. In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis. However, a delayed reaction did occur within 48 h in the form of severe multi-organ dysfunction. There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize. This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.