Acute pulmonary hemorrhage following a honeybee sting: a case report

A generalized allergic reaction to or anaphylaxis from honeybee sting may involve the skin with erythema, puritus, urticaria, or angioedema; the respiratory tract with laryngeal edema, and brochospasm; the cardiovascular system with myocardial depression, hypotension, and shock; and the gastrointestinal system with nausea, vomiting, and incontinence. Acute pulmonary hemorrhage following a honeybee sting has never been reported. We describe a previously healthy 14-year-old girl who developed acute pulmonary hemorrhage, hypotension, and generalized skin rash after a single honeybee sting on her right fourth finger. Her serum immunoglobulin E (IgE) was high (360 IU/mL). Chest X-ray revealed perihilar alveolar infiltrative lesions. Metabolic acidosis and hypoxemia were also found. After treatment with antihistamines, dopamine, corticosteroids, bronchodilaters, fluid replacement, and mechanical ventilation, her condition improved dramatically. A hypersensitivity reaction to honeybee venom is the most likely explanation for this unusual case of acute pulmonary hemorrhage.