Scorpion sting-induced unilateral pulmonary edema

Abstract

A five-year-old male was admitted to the emergency department of the Reference Service 2h after being stung by a scorpion (Tityus serrulatus) and about 30min after, five vials of polyvalent serum antivenom of the Ezequiel Dias Foundation/FUNED, Belo Horizonte, State of Minas Gerais, Brazil were given to the patient. On examination he was pale, disoriented and respiratory rate of 70 per min. Upon lung auscultation, there were decreased breath sounds on the right and crackles in the left lung base, while the cardiovascular revealed a gallop rhythm (B3). The findings on chest radiography were diffuse bilateral infiltrates and pulmonary congestion, more evident on the right side ( Figure A). On the third day of hospitalization, chest X-ray showed opacification and an improvement in pulmonary congestion ( Figure B). By the tenth day of hospitalization, was discharged in stable condition. Prior to discharge, the radiographic evaluation of the chest showed significant resolution of the acute pulmonary edema (APE) (Figure C). Scorpion intoxication is an important public health problem in many tropical and subtropical countries, such as Brazil. The symptoms are variable and can change rapidly in a negative way. In children are common to pallor, tachycardia with hypertension, the costal retractions and the throbbing of the nostrils, whereas the pink sputum is not always observed. APE caused by scorpion intoxication is well-known, but this occurs rarely unilaterally and its pathogenesis is incompletely understood. In this patient the occurrence of asymmetric APE induced by scorpion was clinically suspected and documented through the chest radiographs.Paciente de 5 anos, masculino, foi admitido na emergência de um Serviço de Referência 2h após ter sido picado por um escorpião (Tytius serrulatus) e, cerca de 30min após foram administrados cinco frascos de soro polivalente antiescorpião da Fundação Ezequiel Dias/FUNED, Belo Horizonte, Minas Gerais, Brasil. Ao exame encontrava-se pálido, desorientado e com frequência ventilatória de 70ipm. A ausculta respiratória demonstrou diminuição do murmúrio vesicular à direita e crepitações na base do pulmão esquerdo, enquanto a cardiovascular revelou ritmo em galope (B3). Os achados na radiografia de tórax foram infiltrados difusos bilaterais e congestão pulmonar, mais evidente à direita (Figura A). No terceiro dia de internação, a radiografia de tórax evidenciou melhora das opacificações e congestão pulmonar (Figura B). No décimo dia de internação, o mesmo recebeu alta em condições estáveis. Neste momento, a avaliação radiográfica do tórax mostrou resolução significativa do edema agudo do pulmão (EAP) (Figura C). O acidente escorpiônico é um importante problema de saúde pública em vários países tropicais e subtropicais, como o Brasil. A sintomatologia é variável e pode evoluir rapidamente de forma negativa. Em crianças são comuns a palidez cutânea, a taquicardia com hipertensão, as retrações costais e os batimento de aletas nasais; já a expectoração rósea, classicamente descrita em adu...

Saudi medicinal plants for the treatment of scorpion sting envenomation

“…From the ancient time plant products were the most successful remedies because of better compatibility with the human body and enhanced acceptability in human societies. Most frequent manifestations of scorpion envenomation are pulmonary oedema (Goncalves et al, 2012), myocardial damage (Maheshwari and Tanwar, 2012), intracerebral haemorrhage (Dube et al, 2011), brachial plexopathy (Rubin and Vavra, 2011) and renal failure (Naqvi et al, 1998), induced by the prolific release of neurotransmitters (Ismail, 1995, Natu et al, 2010). Prazosin is a common supportive therapy for scorpion envenomation (Natu et al, 2010).…”

Problems and Paradoxes of Animal Toxins and the Heart

“…63 Unilateral occurrence of pulmonary edema, though rare (Figure 4.2), can be attributed to a simultaneous and localized increase in pulmonary vascular permeability induced by scorpion venom. 64 The release of vasoactive, inflammatory, and thrombogenic peptides and amine constituents (e.g., histamine, serotonin, bradykinin, leukotrienes, thromboxane), which act on the coronary vasculature and induce coronary artery vasospasm, platelet aggregation, and thrombosis, leads to myocardial ischemia or infarction. 65 Release of allergenic proteins causes anaphylactic shock leading to hypotension with vasodilation and decreased intravascular volume with reduced myocardial perfusion.…”

Unilateral pulmonary oedema: Rare manifestation of scorpion sting

“…Bilateral pulmonary oedema is common whereas unilateral oedema is unusual. [2] Previously reported cases of unilateral pulmonary oedema occurred within few hours of scorpion sting. [2] This case report presents development of unilateral pulmonary oedema more than 24 h after scorpion sting.…”

“…[4] The mechanism of acute pulmonary oedema induced by scorpion venom is not completely understood. [2] It may occur due to both cardiogenic and non-cardiogenic causes. [56] The occurrence of unilateral pulmonary oedema in our patient could be due to the above reasons or mitral regurgitation as evidenced by Doppler echocardiography.…”