Rare Survival After 200 Bee Stings and Severe Anaphylaxis in an Urban Environment: A Case Report

Gihwan Han MD, Jungje Park MD, Adamari Macias Cardona, Manuel Diaz, MD, Krishan Shivam Chaddha, DO, Heesun Choi DO

Received : August 21, 2025 | Published : October 01, 2025

Citation: Han G, Park J, Cardona AM, Diaz M, Chaddha KS, Choi H. Rare Survival After 200 Bee Stings and Severe Anaphylaxis in an Urban Environment: A Case Report. J Case Rep Rev Med. 2025;1(4);1-3. DOI: 10.64978/jcrrm-0102

Abstract

Introduction: Massive bee stings leading to severe anaphylaxis are rarely survived, with most documented cases especially those involving more than 200 stings resulting in fatality or lasting complications. This case highlights the impact of immediate intervention starting in the prehospital setting, and demonstrates that such incidents may occur even in urban environments.

Case Report: A 64-year-old man with no significant medical history presented after being attacked by a swarm of bees, sustaining over 200 stings while working outdoors in Rancho Mirage. He rapidly developed facial swelling, tongue swelling, dyspnea, diffuse rash, and hypotension. Epinephrine was administered by emergency medical services (EMS) at the scene, followed by intravenous fluids and diphenhydramine. On arrival, he appeared ill, with marked periorbital edema, numerous papular lesions, and hundreds of visible stingers. Prompt removal of stingers, repeated doses of epinephrine, along with corticosteroids, intravenous fluids, and antihistamines, led to rapid clinical improvement. Laboratory studies revealed high anion gap metabolic acidosis, hyperglycemia, and mild renal insufficiency. The patient was discharged in improved condition with epinephrine auto-injector and planned follow-up.

Conclusion: This case demonstrates that immediate recognition and guideline-based management of massive bee envenomation, starting in the prehospital setting, can be lifesaving. Emergency clinicians should recognize that such life-threatening envenomations may occur in urban as well as rural settings.