Persistent severe muscle pain following mistakenly injected high-dose bee venom: A care-compliant case report

Rationale: In clinical practice, bee venom injection into acupuncture points is used to relieve various types of musculoskeletal pain. In the current study, we describe a patient who had persistent severe muscle pain caused by mistakenly injected high-dose bee venom. Patient concerns: A 63-year-old woman mistakenly received an injection of high-dose (2 mL; standard dose, 0.1 mL) bee venom (diluted in saline at a 1:2000 ratio). Immediately after the injection, extreme burning pain developed at the injection site, which persisted for 1 month with a mean pain score of 9 on the numeric rating scale. T1-weighted gadolinium-enhanced axial lumbar magnetic resonance imaging revealed increased intensity in the medial part of the left psoas muscle around the L4-5 intervertebral disc level. Diagnosis: This finding indicated the presence of inflammation in the left psoas muscle, which was thought to be associated with pain. Interventions: A buprenorphine transdermal patch (releasing 5 mcg/hours) was applied to alleviate the pain. Outcomes: Six months after the bee venom injection, the pain completely resolved. Lessons: Bee venom has a strong toxic effect; therefore, only a minimal dose of diluted bee venom should be administered for musculoskeletal pain control. Special caution is required during bee venom injection to avoid excessive doses of bee venom.