Acute Liver Injury, Rhabdomyolysis and Acute Renal Failure in a Toddler due to Multiple Stings by Vespa affinis SD01-SD03
Dr. SR Ravikiran,
Professor, Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education,
Mangalore-575001, Karnataka, India.
Vespa affinis stings are known to produce local as well as systemic toxic manifestations including haemolysis, rhabdomyolysis, renal injury, hepatic toxicity and encephalopathy. However, very few pediatric cases of Vespa affinis stings have been reported. We report an unusual case of a toddler with hornet stings (10 in number) who presented to our hospital 72 hours after the sting and met with a fatal outcome. At the time of presentation, child was in altered sensorium and shock with multiple necrotic sting marks. Blood investigations were suggestive of acute renal failure with dyselectrolytemia, rhabdomyolysis and toxic liver injury. Child was managed conservatively with intravenous fluids, renal sparing antibiotics, inotropes, fresh frozen plasma and intravenous high dose steroid (Methyl Prednisolone 30 mg/kg/dose). However, the child deteriorated and had a cardiac arrest the same day. She was resuscitated, intubated and connected to a ventilator. The condition worsened and the child succumbed to death. Since there is no specific treatment, a rare case of hornet bite with acute toxic liver injury and rhabdomyolysis could be a challenge to treat.