Acute myocarditis induced by scorpion sting: a report of five cases and a review of the literature - abstract

ABSTRACT

The clinical features in five cases (two fatal) of acute myocarditis induced by scorpion stings in Trinidad included hypovolaemic shock, restlessness, convulsions, cerebral oedema, pulmonary oedema, pancreatitis and myocarditis. The 2 fatal cases showed myocarditis (round cell perivascular infiltrate) and marked perivascular oedema of the endomysium, pulmonary oedema and marked cerebral oedema. The clinical course in these 5 patients suggests that generalized oedema occurred within minutes which would indicate that vascular endothelial damage occurred early, It is postulated that the venom complex of the scorpion, Tityus trinitatis, acts directly on endothelial cells leading to marked vascular permeability, and/or indirectly through agents such as serotonin and kinins to produce the same effect. Therapy should therefore be directed towards correction of the hypovolaemic shock, removal of oedematous fluid from the extravascular space, maintenance of adequate ventilation, reduction of cerebral oedema, digitalization and stabilization of the vascular endothelial membrane (AU)