Honey Bee Sting in the Esophagus: A Case Report

The patient was a 59-year-old man who was drinking Coca-Cola in his backyard when he suddenly developed an excruciating pain in the cervical area. He had nausea but no vomiting. There was no chest pain or dyspnea. Convinced that he had swallowed the opening tab of the Coca-Cola can, the patient attempted to regurgitate the object up with no success. He came to a community ER, where his neck X-ray was unrevealing. He was then transferred to a hospital with GI coverage. The patient underwent an emergent EGD for the working diagnosis of “foreign body object impaction.” EGD found the larynx and the upper esophagus edematous and erythematous. The middle and lower esophagus was normal. The stomach had an antral polyp. The duodenum was normal. There was no can opening tab. 

The upper esophagus was re-examined with careful inspection. There was an insect stinger with an attached venom sac deeply imbedded into the upper esophagus, immediately distal to the level of the cricopharyngeus. We used a biopsy forceps to gently dislodge, grasp, and remove the stinger without squeezing the venom sac. The patient was given diphenhydramine 25 mg IV and dexamethasone 10 mg IV in the GI lab. He soon felt better and was discharged home. The specimen was inspected under microscopy. It consisted of a 3 mm x 1 mm x 1 mm needle-like fragment attached to a small amount of soft tissue at one end. In the soft tissue, there were muscle cells with centrally placed nuclei indicative of a nonhuman origin. Portions of the specimen were covered with chitin, consistent with exoskeleton of an arthropod. Overall, the specimen was determined to be a stinger of a honey bee. Patient’s symptoms completely resolved on follow-up.

Thomas Tran, MD,1. Pete Chambers, DO,2. 
1. Texoma Medical Center, Denison, TX; 
2. Integris Marshall County Medical Center, Madill, OK.

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