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<p>Hymenoptera anaphylaxis led to the death of a bee and wasp venom sensitized 41-year-old man suffering from systemic indolent mastocytosis. While at work in a vineyard, the man suffered a serious anaphylactic crisis and cardiovascular arrest; despite ongoing attempts of resuscitation, he died in hospital 12&#xa0;h after being stung. Autopsy confirmed that death was due to post-anoxic brain damage, cardiovascular shock, disseminated intravascular coagulation (DIC) and multi-organ failure (MOF). ICU blood samples drawn before the patient’s death from the distal extremity of the pulmonary catheter revealed central blood tryptase levels of 8955 ng/mL; samples drawn 6 days after death, at autopsy, confirmed anaphylaxis diagnostic central blood total tryptase levels (4977 ng/mL) and peripheral blood levels (319 ng/mL); IgE levels in ICU blood sample suggested that the farmer was a responder to venom immunoteraphy (VIT) for <i>Apis Mellifera</i> (IgE 0.44 kUI/L) but not for <i>Polistes Dominulus</i> (IgE 3.13 kUI/L) yet. The comparison of perimortem laboratory results was crucial, in association with autopsy findings and circumstantial data, in ascertaining that death was caused by a wasp venom anaphylactic reaction, with key findings being: 1) Significantly high pre-mortem (8955 ng/mL) and post-mortem (4977 ng/mL) central blood tryptase levels. 2) High post-mortem peripheral blood tryptase levels (319 ng/mL). 3) High pre-mortem central blood IgE antibodies against <i>Polistes Dominulus</i>.</p>

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Fatal anaphylactic shock due to hymenoptera venom in a farmer suffering from indolent systemic mastocytosis. The comparative diagnostic relevance of perimortem serum tryptase levels

  • 期刊论文

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  • 发表日期：

    2025年4月2日

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  • Ugo Da Broi,
  • Francesco Simonit,
  • Maurizio Perogio,
  • Daniela Visentini,
  • Federico Reccardini,
  • Rexson Tse,
  • Jack Garland,
  • Benjamin Ondruschka,
  • Lorenzo Desinan

摘要

Hymenoptera anaphylaxis led to the death of a bee and wasp venom sensitized 41-year-old man suffering from systemic indolent mastocytosis. While at work in a vineyard, the man suffered a serious anaphylactic crisis and cardiovascular arrest; despite ongoing attempts of resuscitation, he died in hospital 12 h after being stung. Autopsy confirmed that death was due to post-anoxic brain damage, cardiovascular shock, disseminated intravascular coagulation (DIC) and multi-organ failure (MOF). ICU blood samples drawn before the patient’s death from the distal extremity of the pulmonary catheter revealed central blood tryptase levels of 8955 ng/mL; samples drawn 6 days after death, at autopsy, confirmed anaphylaxis diagnostic central blood total tryptase levels (4977 ng/mL) and peripheral blood levels (319 ng/mL); IgE levels in ICU blood sample suggested that the farmer was a responder to venom immunoteraphy (VIT) for Apis Mellifera (IgE 0.44 kUI/L) but not for Polistes Dominulus (IgE 3.13 kUI/L) yet. The comparison of perimortem laboratory results was crucial, in association with autopsy findings and circumstantial data, in ascertaining that death was caused by a wasp venom anaphylactic reaction, with key findings being: 1) Significantly high pre-mortem (8955 ng/mL) and post-mortem (4977 ng/mL) central blood tryptase levels. 2) High post-mortem peripheral blood tryptase levels (319 ng/mL). 3) High pre-mortem central blood IgE antibodies against Polistes Dominulus.