Scorpion bite-induced unilateral pulmonary oedema

Abstract

A 24-year-old woman came to the emergency room of our hospital, 6 hours after a sting to the pulp of her middle finger of her left upper limb by an Indian red scorpion. On examination, she had tachycardia, tachypnoea, hypotension and low oxygen saturation at room temperature. On auscultation, there was poor air entry in all areas of the right lung along with crackles. The left lung field was normal on auscultation. Chest X-ray showed unilateral haziness of right lung field. Two-dimensional echocardiography showed clinical findings of myocarditis. Arterial blood gas showed metabolic acidosis with severe hypoxaemia, suggestive of type 1 respiratory failure. After intubation and initiating ventillatory support, the patient was given intravenous analgesics, antihistaminic and infiltrated of site of bite with 2% xylocaine. The patient was started on inotropes, alpha receptor blocker, intravenous steroids, bronchodilators and diuretics support. The patient clinically improved over the course of treatment and was subsequently discharged.

Scorpion envenomation-associated myocarditis: A systematic review

“…Symptoms and clinical findings associated with myocarditis included respiratory distress (tachypnea and/or dyspnea), mostly associated with pulmonary edema, cold or cyanotic extremities, hypotension or shock, increased heart rate, and gallop rhythm on heart auscultation. Among these, respiratory distress [ 26 , 28 , 34 , 36 – 38 , 40 , 43 – 48 , 51 , 59 , 63 – 71 , 73 – 92 ] and increased heart rate (tachycardia) [ 13 , 27 , 34 , 36 – 39 , 43 , 44 , 47 , 53 , 56 , 58 , 59 , 61 , 64 – 66 , 68 , 69 , 74 , 75 , 77 – 89 ] were the most common manifestations affecting 94.8% (145 from 153) and 82% (137 from 167) of the patients, respectively. In studies where the prevalence of pulmonary edema could be determined unequivocally, it was observed in 60.7% (246 from 405) of patients [ 13 , 27 , 34 , 36 – 39 , 42 – 44 , 47 , 48 , 51 , 56 , 58 , 59 ,…”

“…Hypertension, despite cardiac dysfunction, was another notable presentation reported in some cases [ 34 , 50 , 51 , 57 , 60 , 66 , 74 , 76 , 82 , 84 ]. Sinus tachycardia was the most common ECG reading [ 13 , 27 , 34 – 38 , 43 , 44 , 47 , 53 , 58 – 62 , 64 – 66 , 68 , 69 , 74 , 75 , 77 – 89 ], followed by ST-T changes [ 13 , 27 , 34 , 36 – 38 , 44 , 47 , 58 , 61 , 62 , 64 , 66 , 68 , 69 , 72 , 75 , 77 – 80 , 82 , 83 , 85 , 89 ]. ST-T changes, including ST segment elevation or depression, T inversion, or tall T waves, were present in 64.6% (84 from 130).…”

“…Ventricular tachycardia was another important finding [ 71 , 75 , 76 , 84 ]. Laboratory findings associated with myocarditis were raised levels of cardiac troponin T [ 49 , 57 , 61 , 64 , 70 , 72 , 75 , 87 ], troponin I [ 34 , 41 , 42 , 45 , 46 , 49 , 58 , 60 , 65 , 66 , 74 , 76 , 78 , 79 , 81 , 82 , 84 – 86 , 88 , 91 , 92 ], unspecified-type troponin [ 63 , 67 , 80 , 82 ], CK-MB [ 14 , 18 , 34 , 37 , 40 , 45 , 46 , 49 , 52 , 57 , 59 , 62 , 66 , 68 , 70 , 74 – 76 , <...…”

“…Echocardiography findings in the studies included regional or global hypokinesia [ 13 , 26 , 34 , 36 – 38 , 45 , 48 , 51 , 52 , 54 , 57 , 59 , 61 , 62 , 67 , 71 , 72 , 75 – 77 , 79 , 81 , 83 – 87 , 90 , 91 ], chamber dilation [ 45 , 53 , 59 , 68 , 69 , 73 , 76 , 80 ], decreased left ventricular ejection fraction (LVEF) [ 13 , 14 , 18 , 26 , 34 , 36 – 41 , 45 , 46 , 48 , 49 , 51 – 55 , 57 – 75 , 77 – 93 ], decreased fractional shortening (FS) [ 37 , 38 , 41 , 48 , ...…”

French Scorpionism (Mainland and Oversea Territories): Narrative Review of Scorpion Species, Scorpion Venom, and Envenoming Management

“…Acute lung edema induced by scorpionic envenomation may present predominately on the right. There is no clear pathophysiological mechanism which explains the right-lung predominance [ 107 , 108 ]. These complications are often described for envenomation by the Buthidae family on French territory, specifically the Tityus genera [ 9 ].…”