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Fatal acute pulmonary oedema and acute renal failure following multiple wasp/hornet (Vespa affinis) stings in Sri Lanka: two case reports

Keerthi Kularatne1, Thamara Kannangare1, Ajith Jayasena1, Aruni Jayasekera1, Roshitha Waduge2*, Kosala Weerakoon3 and Senanayake AM Kularatne4

Author Affiliations

1 District General Hospital, Matale, Sri Lanka

2 Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

3 Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka

4 Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

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Journal of Medical Case Reports 2014, 8:188  doi:10.1186/1752-1947-8-188

Published: 13 June 2014



Vespa affinis is a hornet widely distributed in Sri Lanka and it is responsible for the highest number of deaths related to Hymenoptera stings. Apart from the early reactions, victims often die in hospital many hours later due to complications such as myocardial infarction and multiple organ failure. Increased microvascular permeability and acute pulmonary oedema as the primary pathology is less known in hornet envenoming.

Case presentation

Here, we report clinical and postmortem findings of two Sinhalese patients, a 48-year-old husband and his 46-year-old wife, who both died following a massive attack by hornets 32 hours and 9 hours after the incidence respectively. At postmortem examination, both patients had pleural effusions, acute pulmonary oedema and red cell casts in their urine. Their coronary arteries and histology of myocardium were normal.


Early recognition of acute pulmonary oedema in hornet stings is needed with implementation of crucial treatments to avert deaths.

Acute renal failure; Pulmonary oedema; Sri Lanka; Vespa affinis