Postmortem Assessment of Anaphylactic Shock Due to Hymenoptera Stings (Yellow Jacket Vespula)

After attending this presentation, attendees will understand that Hymenoptera stings (bees, wasps) are among the most common causes of anaphylaxis, defined as a severe, rapid onset of a systemic allergic reaction which, if not promptly treated, can be fatal.

Case Break 3 | CB 3

Friday, February 16, 2023 | 7:15 AM – 7:45 AM | CE Hour: .5

Impact Statement

This presentation will impact the forensic science community by highlighting the role of ancillary postmortem investigations in the diagnosis of anaphylactic shock caused by bee stings when no macroscopically evident signs are detected during either on-spot examination and autopsy.

To this regard, we here present the case of a 45-year-old man who, according to the circumstantial data collected, was hit by a swarm of bees while opening a shed at work, dying shortly thereafter. No signs of bee stings were macroscopically evident during the survey, nor was any sign of anaphylactic shock (angioedema, pharyngeal/laryngeal oedema, petechial hemorrhages) observed during autopsy. The only macroscopic findings consisted of mild pulmonary edema with mild swelling of the upper lip; heart and coronary arteries were macroscopically undamaged.

Considering that the absence of postmortem findings does not necessarily exclude the diagnosis of anaphylaxis (since macroscopic signs can resolve during the postmortem period), to clarify the possible cause of death, histological and biochemical investigations were performed, especially in light of the available circumstantial data. Biochemical assays included serum sampling for Radioallergosorbent testing (RAST) for bee venom specific IgE, which showed positive for the venom of the yellow jacket (type of Vespula); other biochemical tests highlighted an increase in tryptase and troponin; samples of heart, larynx, trachea, lungs, and spleen were also collected for immunohistochemical tests in order to evaluate the mast cells infiltrate using anti-tryptase antibodies.

Therefore, based on anamnestic (absence of any other pathology worthy of note), circumstantial (exposure to bee sting), histological, and biochemical data, the diagnosis of death was stated as due to anaphylactic shock although there was an absence of macroscopic signs at autopsy.

The case showed the importance of second-level investigations for the postmortem diagnosis of anaphylactic shock, highlighting the usefulness of biochemical and immunohistochemical analysis. In complex cases, a multidisciplinary approach, such a criteria exclusion cause of death, represents an important method of investigation. Moreover, in such cases, the circumstantial data can provide important data to perform specific postmortem investigations aimed at finding the substance responsible for the anaphylaxis.

Speakers

Elena Forzese, MD*

Messina University
Messina, ITALY
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Claudina Pitrone, MD*

Messina University
Messina, ITALY
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Daniela Sapienza, MD

Messina University
Messina, ITALY
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Gennaro Baldino, MD

Messina University
Messina, ITALY
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Alessio Asmundo, MD

Messina University
Messina, ITALY
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Chiara Stassi, MD

Messina University
Messina, ITALY
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Elvira Ventura Spagnolo, MD

Messina University
Messina, ITALY
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Cristina Mondello, PhD

Messina University
Messina, ITALY
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