Fatal scorpion envenomation: a case report

Dear Editor,
Scorpion envenomation, also known as scorpionism, is a major cause of morbidity and mortality in certain tropical and subtropical areas of the world [1, 2]. Of the approximately 160 scorpion species found in Brazil, Tityus serrulatus accounts for the most severe accidents [3]. Tityus serrulatus enveno­mation is characterised by local pain, autonomic storm, and cardiotoxicity that can be fatal. Death occurs secondarily to cardiovascular dysfunction that may result in cardiogenic shock [3, 4].

Case presentation

A previously healthy 19-year-old woman was transferred from a small hospital to our emergency department. Approximately five hours before admission, she had experienced severe pain on the right shoulder while getting dressed; she had felt something moving inside her shirt but did not visually detect the agent. This incident was followed by nausea, vomiting, non-productive cough, shortness of breath, and bilateral paraesthesia of the upper extremities. She had no significant prior history and no predisposing cardiac risk factors. She was living in a house under repair that had building material in various rooms and was located in a region with an elevated incidence of scorpionism. Upon presentation to the hospital, the patient exhibited diaphoresis, blood pressure of 116/95 mm Hg, a respiratory rate of 40 breaths per minute, oxy­gen saturation of 68% while breathing ambient air, and a temperature of 37.1°C. A notable finding of lung auscultation was coarse bilateral crackles. Skin examination showed a mild right supraclavicular papule and oedema. The patient was peripherally cool with prolonged capillary refill (> 4 s). The remaining general examinations produced normal findings. Notable laboratory test results included haemoglobin of 16.8 g dL-1, a white blood cell count of 29,340 mm-3, glucose of 289 mg dL-1, serum potassium of 3.6 mmol L-1, creatinine of 1.3 mEq L-1, lactate of 7 mmol L-1 (reference range < 2 mmol L-1), pH of 7.22, pCO2 of 24.4 mm Hg (3.3 kPa), pO2 of 58 mm Hg (7.7 kPa), bicarbonate of 10.4 mEq L-1, base excess of –16.7 mmol, oxygen saturation of 83.9%, CK of 385 U L-1 (reference range < 198 U L-1), troponin of 416 ng dL-1 (reference range < 0.04 ng dL-1), and proBNP of 344 pg mL-1 (reference range < 100 pg mL-1). Platelets count were 302 × 109 L-1, activated partial thromboplastin time (APTT) 41 s, and international normalised ratio (INR) 1.39. An electrocardiogram revealed sinus tachycardia and...


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