An Unusual Case of Bilateral Empyema Associated with Bee Sting

Bee sting in most situations is life threatening. Spectrum of bee sting ranges from mild local reaction to death. The literature regarding the bee sting disease from India is sparse. The rare manifestations of the disease include encephalitis, polyneuritis, myocardial infarction, pulmonary edema, bleeding manifestations, and renal failure. Bee sting infections are rare and no field studies have been performed to determine the exact sequence of events that lead to infection of bee stings and if not treated properly can lead to fatal outcomes. Here we present a case of unusual bilateral empyema associated with bee sting. 1. Introduction The severity and duration of a bee sting reaction can vary from one person to another and at different occurrences in the same individual. These reactions were encountered in only 5% of the patients [1]. The spectrum of bee sting disease ranges from mild local reaction to death. The literature regarding the bee sting disease from India is sparse. Bee venom has many different effects on the human body. This is based on the dose of the bee venom. Bee venom, in certain cases, can have very strong toxic effects on humans. For a person who is hypersensitive to bee venom, even one sting can cause a serious or fatal reaction. Here we are reporting a case of bilateral empyema associated with bee sting. 2. Case Report A 27-year-old male presented with high grade fever, dyspnea, and dysphagia of three-day duration. On examination pulse was 110 beats/min, BP 130/90？mm of Hg, oxygen saturation was 96%; decreased breath sounds were heard in the left lower lung field areas. On the day of admission he developed pain abdomen and worsening of dyspnoea, oxygen saturation reduced to 86%, breath sounds were decreased in the left basal areas, and tenderness was present in left hypochondrium. Chest X-ray was suggestive of left hydropneumothorax and HRCT thorax revealed mediastinitis with left sided empyema (Figures 1 and 2); intercostal drainage tube was inserted, which revealed frank pus. After three days of antibiotic therapy fever, dyspnoea and dysphagia were still persistent, repeat chest X-ray revealed right sided pyothorax, and ICD was inserted on right side. Patient was on empirical antibiotic therapy; patient developed fever and breathlessness. Blood and empyema Culture results were negative. On reevaluation of the patient, he revealed the history of bee sting in the oral cavity three days prior to admission, ENT examination showed oedematous arytenoids leading to mediastinitis and bilateral empyema, barium swallow was performed which