[Hymenoptera sting arthropathy as an occupational injury: a case report]

Hymenoptera (Apid and Vespid) sting reactions represent a specific occupational risk factor for beekeepers, farmers, floriculturists, forestry workers, gardeners, greenhouse workers, fruit dealers, fire-fighters, street sweepers, outdoor workers. As a consequence of the Hymenoptera stings it can appear: acute toxic or allergic reactions and sub-acute symptoms that involve various body systems including the joints in which a Hymenoptera Sting Arthropathy (HSA) may occur. We describe the case of a 54-year-old male farmer beekeeper who developed in 1998 a systemic reaction due to multiple bee stings while he was collecting honey. He was hospitalised at the Policlinico Gemelli in Rome because skin (prick and intradermal test) and in vitro tests had shown evidence of an allergic reaction and had required a venom immunotherapy. During the years the patient had been victim of various episodes of acute arthritis on his interphalangeal joints) and, in one occasion, on his right elbow. The symptoms were localized intense pain and a severe impairment of joint function with inability to perform the work. After 7-14 days of corticosteroid treatment the arthritis subsided. In literature there are similar cases described that, at times, assume a greater severeness and lead to significant functional outcomes. The HSA's aetiology includes pharmacologically active substances (melittin, phosfolipase A2, leukotrienes present in venom), infection, or foreign body synovitis. The relative gravity of the symptoms and the possibility of outcomes all indicate that further attempts must be made in order to prevent HSA.