Scorpion Sting-Associated Cardiotoxicity in an Elderly Patient: A Case Report and Brief Clinical Discussion

Öz

Scorpion stings are generally associated with local symptoms, but they may also cause systemic toxicity, including clinically significant cardiac involvement. We report an 84-year-old woman with a history of hypertension who presented to the emergency department (ED) after a scorpion sting to the left great toe. Her initial complaint was localized pain, and vital signs were stable on admission. Subsequent evaluation demonstrated elevated high-sensitivity cardiac troponin T (hs-cTnT) levels. The initial electrocardiogram (ECG) showed T-wave inversion in V2 and the lateral precordial leads (V5-V6), without dynamic changes on repeat recordings. Transthoracic echocardiography (TTE) showed a left ventricular ejection fraction of 35%, with mild aortic, tricuspid, and mitral regurgitation. Myocardial injury or cardiotoxicity due to scorpion venom was suspected, and one vial (1 mL) of scorpion antivenom was administered intravenously as a slow infusion over 30 minutes in the ED. The patient was admitted to the coronary intensive care unit (CICU), and coronary angiography was recommended; however, she declined the procedure and further in-hospital evaluation and treatment. Acute coronary syndrome could not be fully excluded. She left the hospital voluntarily after informed refusal was documented. At subsequent clinical follow-up, the patient reported no complaints, and repeat cardiac enzyme testing was not suggestive of ongoing myocardial injury. This case highlights that scorpion sting-associated cardiotoxicity can occur in older adults despite minimal systemic manifestations, underscoring the importance of serial ECG, cardiac biomarker monitoring, cardiology consultation, and close observation.

Anahtar Kelimeler

• Scorpion sting
• Cardiotoxicity
• Antivenom
• Autonomic storm

Destekleyen Kurum

This study received no institutional support.

Etik Beyan

Ethics committee approval was not required because this study is a case report.

Teşekkür

None.

Yaşlı Bir Hastada Akrep Sokmasına Bağlı Kardiyotoksisite: Olgu Sunumu ve Kısa Klinik Tartışma

Öz

Akrep sokmaları genellikle lokal semptomlarla ilişkilendirilse de klinik açıdan anlamlı kardiyak tutulum dâhil olmak üzere sistemik toksisiteye de yol açabilir. Bu olguda, hipertansiyon öyküsü olan 84 yaşındaki kadın hasta, sol ayak başparmağından akrep sokması sonrası acil servise başvurmuştur. Başvuru sırasında temel yakınması lokalize ağrı olup vital bulguları stabildi. İzlemde yapılan değerlendirmelerde yüksek duyarlıklı kardiyak troponin T düzeylerinde artış saptandı. İlk elektrokardiyogramda V2 ve lateral prekordiyal derivasyonlarda (V5-V6) T dalga negatifliği izlendi; tekrarlayan kayıtlarda dinamik değişiklik gözlenmedi. Transtorasik ekokardiyografide sol ventrikül ejeksiyon fraksiyonu %35 olarak ölçüldü; ayrıca hafif aort, triküspit ve mitral kapak yetersizliği izlendi. Akrep venomuna bağlı miyokardiyal hasar veya kardiyotoksisite düşünüldü ve acil serviste bir flakon (1 mL) akrep antivenomu intravenöz olarak 30 dakikalık yavaş infüzyon şeklinde uygulandı. Hasta koroner yoğun bakım ünitesine yatırıldı ve koroner anjiyografi önerildi; ancak hasta koroner anjiyografiyi ve ileri hastane içi değerlendirme ile tedaviyi reddetti. Koroner anjiyografiyi kabul etmemesi nedeniyle akut koroner sendrom tamamen dışlanamadı. Bilgilendirilmiş ret formu düzenlendikten sonra hasta kendi isteğiyle hastaneden ayrıldı. Sonraki klinik kontrolde hastanın yakınması olmadığı ve tekrarlanan kardiyak enzim değerlendirmesinin devam eden miyokardiyal hasarı düşündürmediği görüldü. Bu olgu, belirgin sistemik bulgular olmasa bile yaşlı hastalarda akrep sokmasına bağlı kardiyotoksisite gelişebileceğini göstermekte ve risk sınıflaması ile yönetim açısından seri elektrokardiyografi, kardiyak biyobelirteç izlemi, zamanında kardiyoloji konsültasyonu ve yakın gözlemin önemini vurgulamaktadır.

Anahtar Kelimeler

• Akrep sokması
• Kardiyotoksisite
• Antivenom
• Otonomik fırtına

Destekleyen Kurum

Bu çalışma herhangi bir kurumsal destek almamıştır.

Etik Beyan

Bu çalışma bir olgu sunumu olduğu için etik kurul onayı gerekmemektedir.

Teşekkür

Yoktur.

Kaynakça

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