S5515 Hepatitis Bee: Bee Venom-Induced Hepatitis

Introduction: Acute hepatitis is commonly attributed to viral, autoimmune, toxic, metabolic or ischemic causes. Bee venom–associated liver injury is exceedingly rare, with only a few case reports published in international literature. We present a case of an acute liver injury following recent bee stings in a beekeeper, highlighting a rarely recognized cause of hepatotoxicity. Case Description/Methods: The patient is a 70-year-old woman with history of Class III obesity and osteoarthritis, who presented to the emergency department with a 2-day history of profound fatigue, generalized weakness, and back pain. Initial laboratory studies revealed markedly elevated liver transaminases (aspartate aminotransferase and alanine aminotransferase >4000 U/L), international normalized ratio of 6.4. Computed tomography (CT) of the abdomen and pelvis with contrast showed diffuse hepatic steatosis without signs of portal hypertension or cirrhosis. Gastroenterology was consulted for further evaluation of acute liver injury. Extensive workup was unremarkable, including viral hepatitis panel, ceruloplasmin, alpha-1 antitrypsin phenotype, IgG, hemochromatosis mutations, anti-mitochondrial and anti-smooth muscle antibodies. Liver biopsy revealed microvesicular steatosis involving 20%–25% of hepatocytes with stage 2 fibrosis. Upon detailed history, the patient disclosed she works as a beekeeper and had sustained multiple bee stings approximately 1 month prior to symptom onset. Discussion: Bee venom contains cytotoxic components that have been shown to induce oxidative stress and hepatocellular injury in animal models. Human cases of bee sting–associated hepatitis are extremely rare and represent an overlooked cause of acute liver injury. Clinicians should consider envenomation in the differential diagnosis of unexplained hepatitis, particularly in patients with occupational exposure. A thorough clinical history remains essential for identifying unusual etiologies when routine investigations are unrevealing.