Severe acute myocarditis due to scorpion envenoming: unusual presentation in adults

A 21-year-old healthy woman presented to emergency department complaining of severe gluteus pain and progressive dyspnea about one hour after domestic accidental “black scorpion” sting. Despite early scorpion antivenom administration, advanced airway and intensive critical care were promptly required, due to refractory acute respiratory failure (ARF), endorsed by a critical PaO2/ FiO2 of 48. Chest computed tomography revealed diffuse bilateral infiltrates and air bronchograms compatible with acute respiratory distress syndrome. Cardiac troponin levels continuously rose. Initial transthoracic echocardiogram (TTE) revealed diffuse hypokinesia causing moderate left ventricle (LV) systolic dysfunction – rest LV ejection fraction (LVEF) of 0.39 (Simpson ́s method) (Figure 1). Inotrope at low doses (dobutamine 5mcg/kg/min) was then initiated. Follow-up (ninth day) TTE (Figure 2) and cardiac magnetic resonance (CMR) imaging endorsed reversal of initial contractile dysfunction. At eleventh day patient was uneventfully discharged home.