Toxic reaction of a 3-year-old boy due to Hornet multiple stings in Kerman-Iran province: A case report.

A three-year-old boy was attacked by a group of hornets and the head, arms, back and buttocks of the child were targeted to various stings. The child was first taken to a rural clinic and then to a hospital in Baft city. At arrival to rural clinic, the child was conscious and approximately 30 hyperpigmented, painful and itchy papular lesions was seen on his body. Head and neck weren't erythematous and edematous. However gradually, the face, lips, eyelids, and neck became swollen. The child became restless and itchy in the sting sites. Stress induced hyperglycemia occurred. Despite supportive treatments, the clinical conditions get worse and progressed. He referred to the pediatric ward of Afzalipour hospital in Kerman and admitted to intensive care unit (ICU). The child was ill and oliguric. The treatment was started including: hydration with normal saline and diuretic agent (furosemide), insulin, corticosteroid, dopamine and calcium. But a systemic toxic reaction occurred during the hospitalization. Hemolysis, hematuria, anemia, thrombocytopenia and rhabdomyolysis, myoglobinuria, acute renal failure, hepatic injury, epistaxis and respiratory distress was happened. In order to urine alkalinization, sodium bicarbonate was added to his treatments. Also, plasmapheresis was performed. Then according to acute tubular necrosis (ATN) (due to intravascular hemolysis and rhabdomyolysis), pleural effusion and respiratory distress, intermittent hemodialysis was started one day in between. After five intermittent hemodialysis sessions and nineteen days after hospitalization, the patient was discharged in relatively good general condition.