Fatal Anaphylaxis Following Multiple Hornet Stings: A Case Report

Fatal anaphylaxis caused by stings from Hymenoptera insects remains challenging to diagnose postmortem owing to the lack of specific pathologic findings and the influence of postmortem changes on biochemical markers. Herein, we report a rare forensic case involving a 79-year-old woman who was found deceased with numerous hornet stings. Autopsy revealed severe laryngeal edema with substantial narrowing of the airway and extensive subcutaneous hemorrhage at the sting site. Postmortem femoral blood analysis revealed markedly elevated tryptase and histamine levels, indicating mast cell degranulation. There was no evidence of traumatic injury, resuscitation, or acute cardiac pathology. Despite the unusually high number of stings, toxic envenomation was excluded based on the biochemical profile and absence of systemic organ damage. This case highlights the forensic importance of integrating scene investigations, autopsy findings, and postmortem biochemistry to differentiate anaphylactic shock from venom toxicity in cases of death involving multiple stings. Overall, this study offers an efficient approach for postmortem diagnosis of fatal anaphylaxis in complicated sting-related deaths.