Bee sting and cerebral infarction; a mystic relationship.

*Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Received: 09.08.2012; Accepted: 08.02.2014 Sir, I read with interest the case presented by Rajendiran C et al . enti t led:” Stroke after multiple bee sting” recently published in J Assoc Physicians India.1 The authors have presented a 25-yearold male referring to them after being bitten by multiple bees in head and neck region. They describe that the patient was discharged after he had been treated by antihistamines and anti emetics. On the next day, the patient experienced an extensive infarction in his right frontoparietal, right occipital, and right gangliocapsular regions of the brain which were attributed to the bee sting and treated by anti-edema measures, anti-platelet drugs, and physiotherapy. Although an interesting case, the authors might have missed something important about their case. As you know, some antihistamines including loratadine and chlorpheniramine,2,3 can cause cerebral infarction. The risk of loratadine-and chlorpheniramine-induced cerebral infarction has been reported to be 0.2% and 0.6%, respectively. Although the authors have not mentioned the type of the antihistamine administered to their patient, the chance for occurrence of such complication by other antihistamines has not been completely excluded. On the other hand, most of the clinical cases of cerebral infarction following bee stings reported in the literature are of the years before 2000 in which the physicians were not generally aware of the potential side effects of the antihistamines they used for the treatment of allergic reactions. How could the authors exclude such reason for development of cerebral infarction in their patient? Thank you for this very interesting case.