Critical Upper Airway Edema After a Bee Sting to the Uvula

Hymenoptera stings of the upper airway are rare events, but can result in rapid, life-threatening airway emergencies. The allergenic and toxic mediators that are released from the stings of bees, wasps, and hornets can cause local tissue inflammation and edema with subsequent upper airway obstruction. We report the case of a 15-y-old girl who suffered a bee sting to the uvula while zip-lining in Costa Rica. Shortly thereafter, she developed a choking sensation with associated dysphonia, odynophagia, drooling, and respiratory distress. She was brought to a rural emergency medical clinic where she was noted to have an erythematous, edematous, boggy uvula, with a black stinger lodged within it, as well as edema of the anterior pillars of the tonsils and soft palate. The stinger was removed with tweezers and she was treated with an intravenous corticosteroid and antihistamine. She had persistence of airway edema and symptoms until the administration of epinephrine, which resulted in clinical improvement shortly thereafter. In our review of this case and the existing literature, we emphasize the importance of early recognition and management of hymenoptera stings of the upper airway, which should always include immediate manual removal of the stinger, and in cases with significant upper airway edema, the administration of epinephrine should be considered.