Toxic myocarditis following scorpion sting in a child: a case report and pediatric management approach.

INTRODUCTION AND

IMPORTANCE

Scorpion envenomation is a common issue in tropical regions, with cardiac complications being rare but potentially fatal. This case highlights the first reported instance of toxic myocarditis due to scorpion sting in Iran, emphasizing the need for awareness and documentation. CASE PRESENTATION: A 3.5-year-old girl with no prior medical history was admitted after a Hemiscorpius lepturus scorpion sting, presenting with hypotension, anaphylactic shock, and decreased consciousness. She received treatment with epinephrine, scorpion antivenom, and supportive care. Cardiac evaluation revealed toxic myocarditis, confirmed by reduced ejection fraction and elevated cardiac biomarkers. The patient also experienced a seizure, treated with phenytoin. After 10 days of treatment, her cardiac function and consciousness improved, and she was discharged with partial recovery. Follow-up showed normal cardiac function and resolution of symptoms. DISCUSSION: Scorpion envenomation is a significant health issue in Iran, especially in rural regions. A rare case of toxic myocarditis was reported after a H. lepturus scorpion sting in Birjand. Scorpion venom can cause severe cardiovascular effects, including myocardial infarctions and myocarditis. The venom’s rapid spread through the bloodstream led to the quick onset of severe symptoms in this case. Despite the controversial use of antivenom due to potential allergic reactions, prompt treatment with antivenom and supportive care helped stabilize the patient. This case highlights the importance of early diagnosis and monitoring for severe complications in scorpion envenomation.

CONCLUSIONS

This case underscores the importance of quick and comprehensive diagnosis and treatment of scorpion stings, especially severe complications like toxic myocarditis, anaphylaxis, and seizure. Prompt antivenom administration, supportive care, and continuous monitoring can significantly improve recovery. Additionally, increased awareness of scorpion stings in new areas, due to climate change, is crucial.