For more than 60 years, sporadic cases of massive summer honey bee larvae mortality in colonies located near freshwater systems with abundant riparian vegetation have been reported in Uruguay. This odd phenomenon, known as “River disease” by beekeepers, can lead to colony death by depopulation. The aim of this study was to detect the causes of larvae death. Different experiments and analyses were performed using affected apiaries located between two important water courses. 1 day old larvae were the most susceptible and substances that killed the larvae were present in the nectar but not in the pollen. A palynological analysis of nectar samples showed that bees collect this resource from commonly pollinated floral species in the country. However, abundant fungi spores and conidia were found, which indicates that the bees also collected honeydews. In the riparian vegetation, bees were observed collecting the secretions of the planthopper Epormenis cestri on Sebastiania schottiana trees. It was found that the mortality period of larvae overlaps with the presence of E. cestri. Larvae maintained in the laboratory were fed (i) nectar from healthy colonies, (ii) nectar from affected colonies, and (iii) secretions of E. cestri. The mortality of the larvae that received nectar from colonies affected with River disease and secretions of E. cestri was higher than the mortality of those receiving nectar from healthy colonies. This represents the first report of planthopper honeydew causing mass larval mortality in honey bees.