A case report: Myocarditis and pulmonary edema after scorpion sting

Abstract

Akrep sokmaları, ısırılma yerine ait lokal reaksiyonlardan, ölüme yol açacak çoklu organ tutulumlarına kadar geniş bir yelpazede klinik bulgulara neden olur. Isırılma sonucu yaşamı tehdit eden en önemli organ tutulumu kalp ve akciğerlerde görülür. Pulmoner ödem ve miyokardit gibi ölümcül komplikasyonlar nedeni ile her akrep sokması ile karşılaşan çocuk hasta gözlem altında tutulmalı, komplikasyonlara karşı yakın takip edilmelidir. Bu makalede akrep sokmasının ender fakat ciddi komplikasyonlarından olan miyokardit ve pulmoner ödemin geliştiği 4 yaşındaki olgunun takip ve tedavi aşamaları sunulmuştur.

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 , <...…”

“…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 ].…”

“…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 ].…”

“…Standard heart failure treatment, including inotropes as well as diuretics to treat cardiogenic shock and pulmonary edema, was used in almost all studies. Dobutamine was the most widely used agent to treat shock in scorpion stings [13,14,18,26,35,36,38,40,41,43,45,46,48,49,56,58,[61][62][63][64]67,68,71,73,78,80,81,83,84,[86][87][88][89]92]. Mechanical ventilation was required in 35.2% (87 of 247) of cases to treat respiratory failure [14,18,26,[34][35][36][37][38]40,[43][44][45]47,57,…”

“…Dobutamine was the most widely used agent to treat shock in scorpion stings [13,14,18,26,35,36,38,40,41,43,45,46,48,49,56,58,[61][62][63][64]67,68,71,73,78,80,81,83,84,[86][87][88][89]92]. Mechanical ventilation was required in 35.2% (87 of 247) of cases to treat respiratory failure [14,18,26,[34][35][36][37][38]40,[43][44][45]47,57,[61][62]…”