Case ReportsA Fatal Case of Acute Renal Failure From Envenoming Syndrome After Massive Bee Attack A Case Report and Literature ReviewHughes, Rhome L. MD, MSAuthor Information From the University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND. Manuscript received August 23, 2018; accepted October 17, 2018. The author reports no conflict of interest. Reprints: Rhome L. Hughes, MD, MS, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd, Grand Forks, ND 58203. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: March 2019 - Volume 40 - Issue 1 - p 52-57 doi: 10.1097/PAF.0000000000000451 Buy Metrics Abstract Envenoming syndrome is a systemic toxic reaction to the inoculation of large volume of insect venom, typically after a swarm attack from bees. Africanized honey bees are notorious for their aggressive nature, and human deaths resulting from Africanized honey bee attacks are consistently reported. Whereas anaphylaxis is the most common lethal mechanism of injury, delayed deaths can also occur as a consequence of severe venom toxicity with resultant end organ damage. Acute renal failure complicating massive envenomation is a rare but potentially fatal outcome after Africanized honey bee attack and may be heralded by laboratory evidence of rhabdomyolysis. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.