Wasp Stings Induce AKI with Extreme Leukocytosis: A Case Series

Introduction: Acute kidney injury (AKI) is a rare but significant complication of multiple wasp stings that occurs in association with intravascular hemolysis, rhabdomyolysis, and hepatic dysfunction. However, AKI associated with extreme leucocytosis (≥ 35 × 10^9 leukocytes/L) and a complicated clinical course is even rarer and not well-documented. We present a case series of three patients who developed this rare condition due to multiple wasp stings, requiring intensive care, dialysis, and prolonged hospitalization. Case Description: Three patients presented with AKI following multiple wasp stings. Laboratory investigations revealed hemolysis, rhabdomyolysis, acute liver injury, and extreme neutrophilic leucocytosis. Demographic, clinical, and laboratory characteristics are summarized in Table 1. Case 1 developed flaccid quadriparesis due to motor axonal neuropathy and was treated with three sessions of plasmapheresis. Case 2 and Case 2 developed acute respiratory distress syndrome and were managed in the intensive care unit. Each case was managed with broad-spectrum antibiotics, renal replacement therapy, and supportive care. Despite the severity of the illness and complications, all three patients recovered fully, with normalization of renal function tests and liver function tests at follow-up visits 6–8 weeks post-discharge. Discussion: Multiple wasp stings can lead to severe complications. The presence of extreme leucocytosis, mimicking sepsis, may serve as an early indicator of a potentially severe and prolonged disease course. The etiology of extreme leucocytosis may be multifactorial. The acute stress response, inflammatory cytokine release, direct stimulatory effects, and immune system activation occur despite the absence of infection. Prompt recognition, early initiation of dialysis, and aggressive supportive care are essential for recovery.