Background: Multiple organ dysfunction can occur after a large number of honey bee stings, typically developing 24 to 48 hours after the stings.
Case presentation: This report describes three cases of multiorgan dysfunction following multiple honeybee stings. Case 1 presented with abnormal renal and liver function. Laboratory investigations revealed leukocytosis (17,000 cells/µl), elevated serum lactate dehydrogenase (925 U/L), and creatine kinase-MB (283 U/L), suggestive of rhabdomyolysis. Urinalysis showed dark-colored urine with marked albuminuria (3+ or > 3 g/24 h). Serum urea (101.8 mg/dl) and creatinine (5.01 mg/dl) were elevated, consistent with acute kidney injury. Liver function tests demonstrated elevated total bilirubin (3.39 mg/dL), indirect bilirubin, and transaminases, consistent with acute liver injury. The patient underwent three sessions of hemodialysis and showed continuous clinical improvement over the following two days. Case 2 involved cerebrovascular stroke secondary to multiple honeybee stings, and Magnetic resonance imaging of the brain demonstrated multiple acute infarcts, and Laboratory investigations were within normal limits. Case 3 presented with severe generalized pain and tachycardia, and Laboratory investigations were within normal limits. Pain was managed effectively using a combination of analgesics, including non-steroidal anti-inflammatory drugs and opioids such as fentanyl and buprenorphine.
Conclusion: When an individual sustains more than 20 stings, the volume of venom injected can lead to multiorgan dysfunction. Such patients require urgent medical attention and may necessitate intensive care unit management to minimize the risk of severe anaphylactic reactions.