Hemolytic uremic syndrome following Hemiscorpius lepturus (scorpion) sting

Abstract

Scorpion envenomations are a public health problem in many countries. Scorpions are second only to snakes in causing human fatalities from envenomation. Species of scorpions capable of inflicting fatal stings are living in North and South Africa, the Middle East, India, America, Trinidad, and Tobago. Hemiscorpius lepturus (from the Hemiscorpiidae family) is the most medically important scorpion in Iran which accounts for 92% of all hospitalized scorpion sting cases. The venom from H. lepturus is primarily a cytotoxic agent and has hemolytic, nephrotoxic, and to some extent, hepatotoxic activities. We found a combination of microangiopatic hemolytic anemia, thrombocytopenia, and acute renal failure in a seven year-old female child who was referred to us with a 12 h history of bloody urine following a H. lepturus sting. Her blood smear showed fragmented erythrocytes and burr cells, leading us to a diagnosis of hemolytic uremic syndrome (HUS). This report highlights the importance of acceptable prophylaxis and therapeutic protocols for HUS in these patients.

Characteristics and Lethality of a Novel Recombinant Dermonecrotic Venom Phospholipase D from Hemiscorpius lepturus

“…Our comprehensive literature review revealed that the major clinical signs of H. lepturus envenomation [8,11,12,13,14] are similar to those caused by Loxosceles genera (brown spiders) [15,16,17]. This observation may indicate the existence of major homologous toxins in both venoms.…”

“…The sting of H. lepturus leads to various symptoms, including cutaneous reactions varying from undetectable small areas of erythema to large areas of dermonecrotic lesions at the sting site. In severe cases, the scorpion sting can trigger systemic effects characterized by persistent inflammation, vascular leakage, platelet aggregation, cardiovascular disease, severe hemolysis and hematuria, which can lead to renal failure [8,11,12,13]. These systemic disturbances may be attributable to some enzymatic components in the venom of H. lepturus [12].…”

Nephrotic syndrome after scorpion sting

“…Direct venom toxicity to the tissues due to high molecular weight substances like hyaluronidase and sphingomyelinase is reported, potassium channel toxins may mediate vascular contraction by causing smooth muscle depolarization and hence afferent arteriolar vasoconstriction, systemic inflammatory response syndrome, complement activation, myocarditis and adrenergic mediated vasoconstriction may all reduce renal blood flow [6]. In addition haemoglobinuria-related pigment nephropathy [7], haemolytic uraemic syndrome [8] and acute interstitial nephritis [9] are also reported as causes of acute renal failure.…”

Haemolytic uraemic syndrome associated with Klebsiella empyema-case report and literature review

“…D-HUS is associated with invasive Streptococcal disease, and disorders of complement regulation, (Caprioli et al, 2006) while similar histology is seen in adults with thrombotic thrombocytopenic purpura related to ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats) abnormalities and defective cobalamin metabolism, (Valavi and Alemzadeh, 2008). In India, a scorpion sting has caused HUS, Valavi and Alemzadeh (2008). Klebsiella spp are a group of Gram negative bacteria that belong to the Enterobacteriaceae family.…”