CRP3 SEVERE UPPER AIRWAY OEDEMA SECONDARY TO HYMENOPTERA STINGS

 

Hymenoptera stings are a common presentation in emergency departments, particularly among paediatric patients. While most cases are benign, a small subset can develop severe, life-threatening systemic reactions, including anaphylaxis. Airway obstruction due to soft tissue oedema is rare but life threatening, especially in paediatric patients.

 

We report the case of a 10-year-old boy with severe autism who sustained over 50 hornet stings across the face, neck, trunk, and extremities. His initial presentation was relatively mild, with facial swelling and stable vitals. However, he subsequently developed acute kidney injury, gross haematuria, progressive neck and facial oedema, and a reduced level of consciousness (GCS 7/15) due to uremic encephalopathy with no symptoms of tachypnoea or stridor and the ABG was normal. He was planned for intubation, but it was unsuccessful due to severe upper airway oedema visualized on video laryngoscopy. An emergency tracheostomy was performed, and the patient was ventilated for 8 days. He required both intermittent haemodialysis and continuous veno-venous hemofiltration over 12 days. He was treated with intravenous corticosteroids and supportive care. His condition improved, and the tracheostomy was successfully removed. He was discharged on day 26 of admission.

 

This case highlights the severe systemic complications, including airway obstruction and renal failure, following multiple Hymenoptera stings. Clinicians should maintain a high index of suspicion for evolving anaphylaxis and airway compromise, even in initially stable patients. Early airway assessment, multidisciplinary involvement, and preparedness for surgical airway intervention are essential for optimal outcomes in paediatric envenomation cases.