CASE REPORT DOI: 10.3904/kjim.2009.24.3.283 A New Onset of Systemic Lupus Erythematosus Developed After Bee Venom Therapy Young Hee Rho, Jin-Hyun Woo, Seong Jae Choi, Young Ho Lee, Jong Dae Ji, and Gwan Gyu Song Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea Lupus is a systemic autoimmune disease of an unknown origin, and systemic lupus erythematosus (SLE) can be triggered by numerous stimuli. Bee venom therapy is an alternative therapy that is believed to be effective for various kinds of arthritis. We present here a case of a 49-year-old female who experienced a new onset lupus after undergoing bee venom therapy, and this looked like a case of angioedema. The patient was successfully treated with high dose steroids and antimalarial drugs. We discuss the possibility of bee venom contributing to the development of SLE, and we suggest that such treatment should be avoided in patients with lupus. (Korean J Intern Med 2009;24:283-285) Keywords: Lupus erythematosus, systemic ; Bee venoms; Angioedema INTRODUCTION Lupus is a systemic autoimmune disease of an unknown origin, and systemic lupus erythematosus (SLE) is known to be under the immunological influence of Th2 [1]. Bee venom therapy is an alternative therapy that is believed to be effective for various kinds of arthritis [2]. We present here a case of a new onset SLE after the patient underwent bee venom therapy, and the clinical picture resembled that of angioedema. CASE REPORT During November 2004, a 49-year-old female patient visited the rheumatology clinic at Korea University Medical Center. She complained of diffuse muscle pain and weak- ness, with arthralgia on her hands, feet, elbows and knees that had persisted for 6 months. She had equivocal morning stiffness and physical findings. With the possibility of autoimmune disease, she was offered laboratory evaluation along with analgesic treatment, but she declined. One Received: January 3, 2007 Accepted: June 22, 2007 month later, the patient was admitted to the infectious diseases division with the chief complaint of dysuria and fever. She was evaluated and treated under the impression of having a urinary tract infection, but treatment was ineffective and any microbial evidence could not be found. She was then referred to the Division of Rheumatology for assessment of her fever and pan-cytopenia. She was found to have undergone a trial of bee venom therapy on her knees 10 days before the admission, which did relieve her arthralgia. Her fever was reported to have begun shortly after the treatment. On inspection, the patient was ill looking and had an edematous, puffy face with swollen eyelids, giving the impression of angioedema. She also had a generalized erythematous papular rash, especially on the trunk (Fig. 1.) There was only a subtle local reaction on the bee venom injection site. Oral thrush was also found, which was later confirmed to be oral candidiasis. Her vital signs were a body temperature of 38.9˚C, a blood pressure of 160/90 mmHg, a heart rate of 96/minutes and a respiration rate of 20/minutes. Suspicious crackles were heard on both lower lungs. She was initially found to have mild costover- Correspondence to Gwan Gyu Song, M.D., Ph.D. Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-818-6667, Fax: 82-2-2626-1137, E-mail: gsong@kumc.or.kr