A reminder of life-threatening reaction of hymenoptera sting cause anaphylaxis shock


  • Ni Putu Nita Wiryandari Departement of Internal Medicine, Wangaya Regional General Hospital, Bali, Indonesia
  • Ketut Suryana Department of Internal Medicine, Merpati Clinic, HIV and Allergy- Clinical Immunology Services Unit, Wangaya Hospital, Denpasar, Bali, Indonesia
  • Dewi Catur Wulandari Department of Internal Medicine, Wangaya General Hospital, Denpasar, Bali, Indonesia




Hymenoptera sting, Large local reaction, Anaphylaxis shock


The prevalence of hymenoptera sting in general population still high. Large local reaction (LLR) is more common manifestation but can also cause anaphylactic shock and loss of consciousness, or even cardiac or respiratory arrest that all is defined as severe systemic sting reaction (SSR). The risk is generally considered low for future SSR in subjects with LLR but need to be considered and recognized immediately. We reported a case of 39-year-old women was stung by a wasp when driving motorcycle and presented to emergency room with anaphylactic shock (fulfill the amended NIAID/FAAN criteria). She also stung by wasp 2 years ago and cause her left upper and lower arms became swollen slowly and improved 3 days later after treatment with allergy drugs. Electrocardiography result refer to sinus bradycardia. Significant laboratory result showed hypokalemia (2.9 mmol/l). Patient treated by injecting epinephrine intramuscularly and glucocorticoids to preventing protracted symptoms and biphasic reactions.  


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