Allergic and systemic reactions following yellow jacket stings
Subramanian, C.; Jain, V.; Singh, M.; Kumar, L.
Indian Pediatrics 37(9): 1003-1005
2000
ISSN/ISBN: 0019-6061 PMID: 10992338 Document Number: 525307
A case is reported of a 12-year-old boy in Chandigarh, India, who developed massive intravascular haemolysis, rhabdomyolysis and acute renal shutdown after being stung by a swarm of yellow jackets (Cespula germanica). Immediately following the incident the boy developed severe pain at the site of the stings and swelling all over the body and within minutes complained of a constricting sensation in the chest. He was treated with iv dexamethasone and chlorpheniramine maleate and 2 h later passed 100 ml of red urine, following which he became anuric. The oedema increased following treatment with iv fluids and diuretics. Examination of the child 72 h after the episode revealed around 250 sting marks spread all over the body. The patient had anasarca, severe pallor, icterus, acidotic breathing and a palpable liver; the spleen was not palpable. Haemolysis was evident by a fall in haemoglobin, unconjugated hyperbilirubinaemia, and increased plasma and urine haemoglobin levels. Muscle pains, increased creatinine kinase levels and urine myoglobin suggested rhabdomyolysis. The child was anuric for 7 days. He underwent peritoneal dialysis at hospital admission, but continued to be anuric so underwent 4 haemodialyses over the next 2 weeks. Urine output, blood pressure and renal parameters normalized in 3 weeks and the patient was discharged after 30 d of hospital stay.