A Case of Fatal Multiple Organ Failure Following Massive Hornet Stings

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We present here in the case of a patient who died of multiple organ failure after being stung by a swarm of hornets (Vespa xanthoptera). The patient was an 80-year-old man who was attacked and stung in 78 places by hornets in a farm field. He was in shock on admission to our hospital about 1hr after the attack. Infusion and intravenous administration of 0.1mg of epinephrine quickly achieved hemodynamic stability. However, blood testing conducted on admission revealed abnormalities such as hepatic dysfunction, rhabdomyolysis and coagulation disorder. Despite administration of fresh frozen plasma (FFP) and steroid, hematological and systemic status deteriorated. Plasma exchange (PE) and continuous hemodiafiltration (CHDF) were initiated about 13hr after the attack, while using a ventilator. However, the patient died of multiple organ failure at 51hr after the attack. A search of the literature revealed 25 reports of organ injury and failure caused by multiple hornet stings in Japan, with 8 deaths. Organ injury was due to hornet toxin in most cases, not anaphylaxis, and most deceased patients sustained>50 stings. If the patient is stung>50 places and displays poor general condition, PE should be performed promptly, followed by CHF or CHDF.
一般社団法人日本救急医学会の論文