Severe Troponin I Elevation and Myocardial Dysfunction in a Child with Scorpion Sting

Abstract

Background Scorpion sting is a common medical problem and major cause of mortality and morbidity in many countries. The symptoms of envenomation are more severe in the pediatric population. The clinical manifestations of scorpion envenomation appear by activation of sympathetic and parasympathetic nervous system. Envenomation can cause multiorgan dysfunction and death. Case Presentation and Findings In this case report, we present a pediatric patient from Adana, Southeast Anatolia, with severe scorpion envenomation with Leiurus abdullahbayrami which is an especially dangerous species for children. Severe systolic dysfunction was detected by echocardiography. Troponin I levels elevated significantly and rapidly responded to three doses of antivenom therapy. Conclusion Early echocardiographic examination is an important procedure for patients with scorpion envenomation. Troponin I is a significant parameter to monitor the degree of cardiac injury. Antivenom therapy is the only recommended specific therapy for children with severe scorpion envenomation due to Leiurus abdullahbayrami. Abnormal echocardiography findings may require repeated doses of scorpion antivenom.

Scorpion envenomation-associated myocarditis: A systematic review

“…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 , <...…”

“…One study reported hemoglobin and plasma protein to be higher in patients with pulmonary edema [ 39 ]. Elevated serum glucose [ 26 , 34 , 37 , 38 , 41 , 47 , 61 , 62 , 65 , 66 , 72 , 73 , 84 , 85 , 87 ], amylase [ 37 , 38 , 44 , 47 , 62 , 81 , 84 , 87 ], creatinine phosphokinase [ 18 , 26 , 38 , 44 , 47 , 51 , 55 , 59 , 62 , 69 , 72 , 74 , 76 , 78 , 90 ], lactate dehydrogenase [ 55 , 78 , 81 , 89 , 90 ], alanine transaminase [ 73 , 83 , 86 , 87 ], aspartate transaminase [ 26 , 44 , 62 , 64 , 73 ,…”

“…Several treatment strategies were presented in the literature. Scorpion antivenom (SAV) [ 36 – 38 , 42 – 44 , 49 , 55 , 56 , 61 , 62 , 65 , 66 , 69 , 74 , 75 , 78 , 80 , 81 , 84 , 85 , 87 , 88 ] was used in most of the studies. Tetanus prophylaxis in the form of tetanus toxoid was also used [ 42 , 65 , 87 ].…”

“…Scorpion antivenom (SAV) [ 36 – 38 , 42 – 44 , 49 , 55 , 56 , 61 , 62 , 65 , 66 , 69 , 74 , 75 , 78 , 80 , 81 , 84 , 85 , 87 , 88 ] was used in most of the studies. Tetanus prophylaxis in the form of tetanus toxoid was also used [ 42 , 65 , 87 ]. Standard heart failure treatment, including inotropes as well as diuretics to treat cardiogenic shock and pulmonary edema, was used in almost all studies.…”

“…Nitrates such as nitroglycerine and sodium nitroprusside were used in several investigations, all of which reported pulmonary edema [ 18 , 56 , 58 , 64 , 66 , 74 , 76 , 87 , 92 ]. Prazosin [ 13 , 14 , 18 , 34 , 58 , 60 , 68 , 75 , 81 , 87 ] and doxazosin [ 42 , 49 , 65 , 88 ] were other used medications. In one case of refractory cardiogenic shock, an intra-aortic balloon pump was used as a means of rescue therapy with a desirable outcome [ 71 ].…”