Abstract
Introduction: Honeybees (Apis mellifera) play a fundamental role in pollination and ecosystem balance. However, agricultural expansion, deforestation, and livestock farming have reduced natural habitats, favoring the presence of hives in human environments and increasing the risk of sting accidents. Although anaphylactic shock is the most frequently reported complication in the literature, massive envenomation can cause severe systemic manifestations, including acute kidney injury and the need for renal replacement therapy.
Case presentation: A 77-year-old male with no relevant medical or occupational history developed anaphylactic shock following a massive Apis mellifera bee attack, requiring initial management with epinephrine. During his clinical course, he experienced progressive deterioration of renal function, meeting criteria for urgent dialysis, which prompted the initiation of RRT with intermittent hemodialysis. Following a multidisciplinary approach in the intensive care unit and targeted management of envenomation effects, renal function improved and urine output recovered, allowing RRT discontinuation.
Conclusions: Severe envenomation from multiple Apis mellifera stings can trigger critical organ failure beyond anaphylaxis, particularly refractory AKI. Clinical severity directly depends on the number of stings and total venom load, both of which determine the development of multiple organ dysfunction.