• Wei-Fan Ou, Wei-Hsuan Huang, Hsien-Fu Chiu, Yan-Chiao Mao, Mei-Chin Wen, Cheng-Hsu Chen, Sheng-Jou Hung, Ming-Ju Wu, Chieh-Liang Wu, and Wen-Cheng Chao.
• Department of Internal Medicine.
• Medicine (Baltimore). 2021 Jan 29; 100 (4): e24492e24492.

IntroductionMultiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings.Patient ConcernsTwo patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis).DiagnosisPatient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings.InterventionsBoth 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17.OutcomesBoth patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2.ConclusionIn conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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