Phylum Arthropoda constitutes more than 50% of the animal species on earth, of which insects, spiders belonging to order Hymenoptera can prove fatal [1].

The three groups of stinging insects under this order belong to the family Apidae (bees), Vespidae (wasps), and Formicidae (ants). These insects are most aggressive when provoked.

They have stinging apparatus at their tail capable of delivering venom [2] stings are of clinical significance in patients allergic to the venom especially in case of multiple stings that can result in death due to anaphylaxis [3].

Most often, it is Type-1 hypersensitivity reaction and is IgE–mediated. Adrenaline, antihistamines, and steroids are the cornerstones in managing the allergic effects of Hymenoptera venom [4].

Bee venom contains histamine, neurotoxins, vasodilators, and hemolysis. Clinical presentation varies from urticarial pruritic local reaction to severe systemic reaction with erythema, vomiting, diarrhea, generalized swelling, laryngeal edema, bronchospasm, dyspnea, hypotension, and acute renal failure [4]. The symptoms following a bee sting may be immediate or delayed reactions.

Immediate reactions are common, well documented that can be local or systemic reactions manifesting within 2 hours of the bite. Delayed reactions are less common, apparent after 2 hours of the sting. The large local reaction may be delayed reaction with the involvement of entire extremity lasting up to a week.

Here we describe a case with local reaction at the site of bee sting progressing to an infected abscess.

A 50-year-old male patient presented with a history of swelling of upper lip following a bee sting 4 days back associated with wheezing, generalized pruritus for which he had consulted elsewhere and received intravenous steroids and antihistamines.

He developed swelling along the right side vermilion border of the upper lip that progressed over the 4 days to involve the entire upper lip. It was associated with redness, pain, and difficulty in mastication. Despite the initial management with steroids and antihistamines, the swelling had

Bee venom is a complex toxin containing a wide array of chemicals including melittin, adolapin, apamin, hyaluronidase, phospholipase A2, histamine are responsible for local and systemic reaction [5] Peptide mellitin comprising approximately 50% of the venom has high toxicity causing hemolysis, inflammatory reactions, capillary leak, smooth muscle contraction, membrane disruption and lysis [6]. The severity of the reactions varies according to the individual’s response and nature of the incident. Allergic reactions to Hymenoptera stings are common among men; particularly those over 30

impairing clearance of infection by the immune system [11,12]. There can be the varied presentation of infections, Klug et al described a case of 25 years old male presenting with toxic shock syndrome; Staphylococcus aureus was isolated from the pustular lesion at the site of a bee sting and he had recovered well with treatment [13]. Alemán Navas et al reported a rare case of a bee sting in the floor of the nose that mimicked an odontogenic infection. The infected bee sting had resulted in mucosal lysis and lip abscess which responded to incision, drainage, and antibiotic therapy [6]. Derlet RW et al described cases of cellulitis following insect bites at various sites that were treated with broad-spectrum antibiotics. Of note, various organisms are known to cause infections in a case of insect bite but gram-positive cocci such as Streptococcal or Staphylococcus species are most common. Hence appropriate antibiotics that cover these organisms should be administered [14].

There are several reports of infection following Hymenoptera stings, but very few describing local reactions with infection in the anatomic location affected in our patient. Early diagnosis and appropriate management of infection may avert serious local as well as systemic complications due to the infection, like in previously reported cases of necrotizing fasciitis.