Lethal Vespa tropica Sting: Clinical Presentation, Autopsy Findings, and Histopathological Observations: A Case Report

The sting of Vespa tropica is well known for causing a strong, allergic, self-limited local reaction, which usually resolves within few days. Unfortunately, in sensitized individuals, it can induce a fatal reaction. A 39-year-old Indian male sustained 4 V. tropica stings. He developed a local allergic reaction and breathing difficulty, but deteriorated rapidly and died within 24 h. Blood investigations revealed an increase in acute inflammatory cells, prolonged coagulation time, and deranged liver and kidney function tests. At autopsy, 4 sting puncture wounds with associated local allergic reactions were identified, and the internal organs were congested. Histopathological examination showed findings consistent with myocardial coagulative necrosis with lymphohistiocytic inflammatory infiltration, renal failure, hepatic injury, pulmonary hemorrhages with interstitial edema. V. tropica venom contains hyaluronidase, phospholipase, dipeptidyl peptidase-IV, antigen 5, and albumin-like proteins. These molecules are capable of inducing local inflammatory reactions, hemolysis, and multi-organ failure. This case report presents a fatality caused by 4 V. tropica stings, with detailed clinical, autopsy, and histopathological observations. These findings may be helpful in the clinical management of patients presenting with potentially lethal V. tropica stings.