Abstract

Background: Wasp stings may cause severe systemic reactions, shock, coagulopathy, multiorgan injury, and death. In forensic practice, determination of the cause of death requires correlation of the circumstances, clinical course, laboratory findings, autopsy findings, histopathology, and toxicology. Case Presentation: We report the case of a 47-year-old man who was stung by wasps at 5:40 p.m. on May 9, 2025, admitted to hospital at 7:00 p.m. on the same day, and died at 2:35 a.m. on May 10, 2025. The patient received intensive resuscitation, mechanical ventilation, continuous renal replacement therapy, and vasopressor support. Laboratory findings showed leukocytosis; severe coagulopathy with prolonged PT, INR, and APTT, and elevated D-dimer; and arterial blood gas analysis revealed severe metabolic acidosis, elevated lactate, and hypoxemia. Blood biochemistry showed elevated creatinine, decreased estimated glomerular filtration rate, markedly increased AST/ALT, hyperkalemia, and marked elevation of CK-MB and troponin I. A forensic autopsy was performed at Binh Duong Provincial General Hospital at 11:30 a.m. on the same day by the Ho Chi Minh City Forensic Center; the forensic case file was recorded under number 138/2025/KLGĐTT- PY. Autopsy findings revealed approximately 100 sting marks on the body, pulmonary edema, subpleural hemorrhage, and pinkish fluid in the airways. Histopathological examination showed inflammatory edema of the skin at the sting sites, cerebral edema, myocardial contraction band necrosis with interstitial lymphocytic infiltration, pulmonary edema with acute inflammatory cell infiltration and multiple microthrombi in small blood vessels, and scattered fatty change of the liver. Conclusion: This case shows that multiple wasp stings may cause a severe systemic reaction and rapidly progress to irreversible multiorgan failure. Correlation between laboratory findings and histopathology demonstrated that cardiac, pulmonary, hepatic, cerebral, and coagulation-related injuries played important roles in the fatal course. In forensic practice, comprehensive assessment of clinical data, laboratory findings, autopsy findings, histopathology, and toxicology is essential to support the determination of the cause of death.