Honey bee sting deaths at medicolegal autopsy: A case series demonstrating variable manifestations of anaphylactic fatality

Abstract

Bee sting deaths represent an uncommon but important forensic problem because death may follow either anaphylaxis after only a few stings or toxic envenomation after massive attacks, while autopsy findings may be subtle and nonspecific. We present three fatal medicolegal autopsy cases from Lucknow, India involving rapid collapse after honey bee attacks, with sting burdens ranging from limited exposure to mass envenomation. Case 1 showed multiple stings over exposed upper body parts with facial edema and generalized congestion but no significant upper airway or pulmonary edema. Case 2 showed multiple posterior body stings, tracheobronchial froth, and markedly heavy edematous lungs. Case 3 showed an estimated 200 stings concentrated over the face and upper body, severe epiglottic and laryngeal edema with luminal narrowing, tracheobronchial froth, and marked pulmonary edema. Together, these cases demonstrate the morphological spectrum of fatal bee sting reactions and underline the importance of integrating scene findings, witness history, sting distribution, and focused airway examination when ancillary tests are unavailable.