Case Report

By Mr. Nawfal Al-Hadithy , Mr. Arshad Khan , Mr. Ashis Banerjee
Corresponding Author Mr. Nawfal Al-Hadithy
Trauma and Orthopaedics, - United Kingdom Lu40DZ
Submitting Author Mr. Nawfal Al-Hadithy
Other Authors Mr. Arshad Khan
Accident and Emergency, Chase Farm Hospital - United Kingdom

Mr. Ashis Banerjee
Accident and Emergency, Chase Farm Hospital - United Kingdom


Allergy, honeybee, sting, ferning, vasospasm, lightening

Al-Hadithy N, Khan A, Banerjee A. Vasospasm Triggered By A Honeybee Sting: A Case Report. WebmedCentral ALLERGY 2010;1(11):WMC001238
doi: 10.9754/journal.wmc.2010.001238
Submitted on: 28 Nov 2010 01:41:05 PM GMT
Published on: 29 Nov 2010 08:30:45 PM GMT


Bee stings are a common worldwide occurrence and most often present with local or systemic allergic reactions. There have been other documented rarer presentations where it has presented with acute coronary syndromes[i] and ischaemic optic neuropathy[ii]. There have been no documented cases of bee sting causing vasospasm in a cutaneous distribution; we present this case to show clinicians the varying signs of allergic reactions.

Case Report(s)

A 12 year old previously healthy male, was admitted to the emergency department after having acute facial swelling following a bee sting to the foot. He had no past medical history of atopy, asthma or any previous allergic reactions. He had been stung by a honeybee 20 minutes before presentation. Despite having some facial swelling, he was haemodynamically stable with no airway compromise, so was bought in to the Emergency department for further assessment by the paramedics. On admission, he was pale but comfortable at rest. His blood pressure was 136/103, pulse was regular at a rate of 110 beats per minute. He was not dyspnoeic and his chest was clear. He had an erythematous patch on his right shoulder, which followed a vascular pattern. There was an absence of cutaneous veins resembling a lightning strike (Fig 1). A punctum was found on the dorsum of his right foot.

He was treated with chlorpheniramine and admitted for observation of his facial swelling and ongoing erythema on his right shoulder. Figure 1 shows the erythema with absence of the cutaneous venous system. Figure 2 shows the resolving erythema 5 hours later.

He had an otherwise uneventful recovery and was discharged the next morning.


Honeybees are from the Apidae family and release apitoxin upon insertion of their stinger into the skin, they are frequently found in forested areas. Bee stings can commonly present with a variety of symptoms ranging from local reactions (pain, swellings, cellulitis) to systemic allergic reactions ranging from mild (local urticarial rash), moderate (angiooedema, asthma) or severe (anaphylactic shock).

Several case reports have shown bee stings to have caused acute coronary syndromes, as the venom has the same physiological effect as histamine and thromboxane, which have vasoconstrictive properties[i].

This pattern has also been seen in victims of lightning strikes. Feathering sign, also known as (keraunographic marks, Lichtenberg’s flowers) have been said to be almost pathognomonic of lightning strikes[ii]. Surprisingly they are not true burns as there is no damage to the skin itself[iii]. One theory for this arborized cutaneous sign is that the transmission of static electricity along the superficial vasculature causes vasospasm.


We have presented a case of an allergic reaction producing a “feathering sign” which is typically seen in lightning strikes. It is important to note that allergic reactions can present in a variety of ways without the typical features of an urticarial rash.


[i] Johnson JL, Jackson CL, Angelini GD. Activation of matrix-degrading metalloproteinases by mast cell proteases in artheroslcerotic plaques.
[ii] Barthlome CW, Jacoby WD, Ramchand SC. Cutaneous manifestations of lightning injury. Arch Dermatol 1975;111:1466.
[iii] Gatewood MO, Zane RD. Lightning injuries. Emerg Med Clin N Am 22 (2004) 369-403

Source(s) of Funding


Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

4 reviews posted so far

Interesting case.
Posted by Ms. Nada Al-Hadithy on 16 Mar 2011 10:17:45 PM GMT

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)