Hymenoptera antigen can cause a wide range of local and systemic reactions and immediate and/or late reactions like serum sickness, acute renal failure, hemolysis, thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), myocardial infarction or cardiac arrhythmias. Most of the insect venom induced allergic responses are type I hypersensivity reactions where IgE plays an important role. Besides the usual immediate type I hypersensivity reactions, type III reaction with deposition of immune complexes and activation of the complement system may also contribute to the pathogenesis of the disease.

Our patient developed renal failure as part of the MODS. Acute renal failure following wasp sting is a well known entity. The usual underlying mechanism causing acute renal failure is an intravascular hemolysis and/or rhabdomyolysis causing pigment nephropathy or acute tubular necrosis.

Although ARDS can be caused by multiple bee stings, that occurring after a single wasp sting is not reported elsewhere in the literature. Our child developed MODS as evidenced by ARDS, acute renal failure, hepatic dysfunction and hemolysis. In our patient the exact mechanism is not clear but massive release of inflammatory mediators and activation of complement cascade may be responsible. The delayed presentation of such a serious and fatal reaction is noteworthy.

» Conclusion

Fatal outcome after this relatively common rural accident usually follows multiple stings resulting in anaphylactic shock. Life threatening complications following single wasp stings are relatively rare and unexpected. Most patients who develop mild urticaria and local pain may not seek medical attention as is the case with our patient. But the onset of fatal reactions can be delayed and complacency either by the patient or by the treating physician can have dangerous consequences. Hence, all patients with history of exposure to such allergens should be observed for atleast 24 hours for late onset complications.