Acute renal failure (ARF) is a rare complication of massive attack by Africanized bees and can be observed 4872 h after the accident [1]. There are nearly 30 cases reported in the literature [2,3]. We report the case of a massive attack of Africanized bees and severe ARF with full recovery of the renal function.
Case. A 55-year-old man was victim to a massive attack by Africanized bees (>500 bee stings) in a rural area in São Paulo, Brazil. On admission to hospital, widespread erythematous and painful papules were found on his body. The patient was discharged from the hospital after oral medication. Six days following the accident the patient sought further emergency medical assistance, complaining of generalized oedema, urinary volume reduction, weakness, pallor and dyspnea. No laboratory evaluation was performed and he was discharged from hospital. Ten days after the accident, the patient returned, presenting with dyspnea, pallor, hypertension, tachycardia, oliguria and generalized oedema. Laboratory exams presented anaemia (haematocrit, 16%; haemoglobin, 5.9 g/dl) and renal function failure (serum creatinine, 27 mg/dl; blood urea nitrogen, 221 mg/dl; serum potassium, 7.8 mEq/l). He was transferred to the Intensive Care Unit (ICU) and endovenous hydration and transfusion of erythrocyte concentrate were initiated. Continuous peritoneal dialysis through Tenckhoff catheter was performed. Clinical improvement was been observed on the second day of treatment, but diuresis recovery was recorded only 20 days after the accident. Peritoneal dialysis was interrupted at 23 days after the accident. Seventy-one days after the attack he had full recovery of renal function (Figure 5).
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The patient in this case experienced ARF without other organ lesions. Surprisingly, preventive measures and diagnosis were not reported at the initial medical consult. Haemolysis and rhabdomyolysis could not be identified through laboratory exams; however, the severe anaemia pointed to a haemolysis-associated picture.
In cases recently reported, ARF was diagnosed and dialysis was indicated up to 48 and 72 h after the accident. The latest ARF diagnosis was carried out 11 days after the accident with partial renal function recovery at 9 month follow-up [1]. Peritoneal dialysis associated with plasmapheresis or haemodialysis have been prescribed as dialytical methods [5]. In our work, the ARF diagnosis was made 10 days after the accident. This late diagnosis and extended dialytical treatment, however, did not prevent the entire recovery of renal function, which has not been described yet in the literature.
Department of Internal Medicina Hospital das Clínicas da Faculdade de Medicina de Botucatu Universidade Estadual Paulista UNESP Rubião Júnior PO Box 584 CEP 18618970 São Paulo Brazil Email: dponcegabriel{at}uol.com.br
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