Published online January 4, 2006
PEDIATRICS Vol. 117 No. 1 January 2006, pp. 231-235 (doi:10.1542/peds.2005-1075)
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EXPERIENCE AND REASON

Massive Honey Bee Envenomation-Induced Rhabdomyolysis in an Adolescent

David P. Betten, MDa,b, William H. Richardson, MDc, Tri C. Tong, MDb and Richard F. Clark, MDa,b

a Division of Medical Toxicology
b Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California
c Department of Emergency Medicine, Palmetto Health Richland Memorial Hospital, Columbia, South Carolina

Massive envenomations by honey bees are capable of causing multiorgan dysfunction as a result of the direct toxic effects of the large venom load received. Although all varieties of honey bee have the potential for these attacks, the Africanized honey bee (Apis mellifera scutellata) is the most commonly implicated subspecies. In the United States, the Africanized strain is found primarily in the southwestern states and is known for its highly defensive behavior if disturbed. Mechanisms behind the multiorgan dysfunction produced by these mass envenomations are not clearly understood. We present a case of a 13-year-old male who was stung by ~700 honey bees and developed progressive upper-body swelling and systemic manifestations of mass envenomation including rhabdomyolysis, renal insufficiency, and a transient transaminase elevation.

Key Words: environmental risk • renal failure • rhabdomyolysis • bee envenomation • Hymenoptera

Abbreviations: CPK, creatinine phosphokinase • IV, intravenous(ly)

Accepted Jun 16, 2005.


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