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Case Reports
. 2025 Jul;139(4):1903-1911.
doi: 10.1007/s00414-025-03487-1. Epub 2025 Apr 2.

Fatal anaphylactic shock due to hymenoptera venom in a farmer suffering from indolent systemic mastocytosis. The comparative diagnostic relevance of perimortem serum tryptase levels

Ugo Da Broi  1 , Francesco Simonit  2 , Maurizio Perogio  3 , Daniela Visentini  4 , Federico Reccardini  5 , Rexson Tse  6   7 , Jack Garland  7 , Benjamin Ondruschka  8 , Lorenzo Desinan  2
Affiliations
Case Reports

Fatal anaphylactic shock due to hymenoptera venom in a farmer suffering from indolent systemic mastocytosis. The comparative diagnostic relevance of perimortem serum tryptase levels

Ugo Da Broi et al. Int J Legal Med. 2025 Jul.

Abstract

Hymenoptera anaphylaxis led to the death of a bee and wasp venom sensitized 41-year-old man suffering from systemic indolent mastocytosis. While at work in a vineyard, the man suffered a serious anaphylactic crisis and cardiovascular arrest; despite ongoing attempts of resuscitation, he died in hospital 12 h after being stung. Autopsy confirmed that death was due to post-anoxic brain damage, cardiovascular shock, disseminated intravascular coagulation (DIC) and multi-organ failure (MOF). ICU blood samples drawn before the patient's death from the distal extremity of the pulmonary catheter revealed central blood tryptase levels of 8955 ng/mL; samples drawn 6 days after death, at autopsy, confirmed anaphylaxis diagnostic central blood total tryptase levels (4977 ng/mL) and peripheral blood levels (319 ng/mL); IgE levels in ICU blood sample suggested that the farmer was a responder to venom immunoteraphy (VIT) for Apis Mellifera (IgE 0.44 kUI/L) but not for Polistes Dominulus (IgE 3.13 kUI/L) yet. The comparison of perimortem laboratory results was crucial, in association with autopsy findings and circumstantial data, in ascertaining that death was caused by a wasp venom anaphylactic reaction, with key findings being: 1) Significantly high pre-mortem (8955 ng/mL) and post-mortem (4977 ng/mL) central blood tryptase levels. 2) High post-mortem peripheral blood tryptase levels (319 ng/mL). 3) High pre-mortem central blood IgE antibodies against Polistes Dominulus.

Keywords: Anaphylactic death; Anaphylaxis; Hymenoptera venom; Indolent systemic mastocytosis; Serum tryptase.

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Conflict of interest statement

Declarations. Consent to Publish: All postmortem examinations referred to this Department were ordered by the Public Prosecutor’s Office and, in compliance with current Italian legislation, the ethical approval was waived because all autopsy data were part of the Prosecutor’s investigations and anonymously evaluated.

Figures

Fig. 1
Fig. 1
Vocal cords oedema - Tracheal mucosal oedema
Fig. 2
Fig. 2
Vocal cord (hematoxylin eosin, 5x) - Focal inflammation
Fig. 3
Fig. 3
Vocal cord (hematoxylin eosin, 20x) - Focal inflammation
Fig. 4
Fig. 4
Lung (hematoxylin eosin, 5x) - Congestion, oedema and phlogistic nodule
Fig. 5
Fig. 5
Lung (hematoxylin eosin, 40x) - Phlogistic nodule with eosinophils
Fig. 6
Fig. 6
Kidney (hematoxylin eosin, 5x) - Diffuse tubulonephrosis
See this image and copyright information in PMC

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