title: Fatal acute pulmonary oedema and acute renal failure following multiple wasp/hornet (Vespa affinis) stings in Sri Lanka: two case reports.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Early recognition of acute pulmonary oedema in hornet stings is needed with implementation of crucial treatments to avert deaths.
authors.forename: Keerthi
authors.initials: K
authors.lastname: Kularatne
authors.forename: Thamara
authors.initials: T
authors.lastname: Kannangare
authors.forename: Ajith
authors.initials: A
authors.lastname: Jayasena
authors.forename: Aruni
authors.initials: A
authors.lastname: Jayasekera
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. roshitha2006@yahoo.com.
authors.forename: Roshitha
authors.initials: R
authors.lastname: Waduge
authors.forename: Kosala
authors.initials: K
authors.lastname: Weerakoon
authors.forename: Senanayake A M
authors.initials: SA
authors.lastname: Kularatne
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology / Q000473:pathology*; D000818:Animals; D002196:Capillaries / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000150:complications / Q000473:pathology*; D007668:Kidney / Q000473:pathology*; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology / Q000473:pathology*; D012867:Skin / Q000098:blood supply / Q000473:pathology; D013188:Sri Lanka; D014699:Venules / Q000473:pathology; D014863:Wasps