Mohammed Salman, Herrera Erica Rae, Kioka Mutsumi
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV, USA.
J Med Case Rep. 2025 Jul 23;19(1):362. doi: 10.1186/s13256-025-05416-7.
Scorpion stings are common in rural areas worldwide, with most cases being benign. However, certain species, such as Centruroides in Southwestern USA, can cause severe neurotoxic envenomations. Neurotoxic symptoms, including nystagmus and ataxia, are well documented in pediatric cases but remain rare in adults. We present a rare case of neurotoxic scorpion envenomation in an adult.
A 32-year-old Hispanic female with a history of anaphylaxis to bee venom presented to the emergency department (ED) following a scorpion sting. While sitting at home, she felt two stings on her posterior right thigh, identified and killed the scorpion, and went to the ED. On evaluation, the patient was alert and oriented (Glasgow Coma Scale score of 15). Her vital signs were stable, and laboratory results were unremarkable. The patient initially experienced localized pain at the sting site, followed by generalized heaviness, muscle twitching, dry mouth, tongue "fuzziness," and throat heaviness but no respiratory distress. Neurological examination revealed nystagmus, tongue fasciculations, and dysmetria, consistent with neurotoxic envenomation. She was treated with a tetanus-diphtheria-pertussis (Tdap) booster, normal saline, ondansetron, lorazepam, and Centruroides scorpion antivenom (ANASCORP). Owing to her anaphylaxis history, she was closely monitored for hypersensitivity reactions. The patient had an uneventful recovery and was discharged after 2 days without neurological complications.
Scorpion envenomations can lead to severe neurotoxic effects, even in adults, particularly with multiple stings or enhanced venom absorption. Early recognition of neurotoxic symptoms is crucial for prompt intervention with antivenom and supportive care, significantly improving patient outcomes. This case emphasizes the importance of considering neurotoxic envenomations in adult patients, even when pediatric cases are more common.
蝎子蜇伤在全球农村地区很常见，大多数病例为良性。然而，某些种类，如美国西南部的Centruroides蝎子，可导致严重的神经毒性中毒。神经毒性症状，包括眼球震颤和共济失调，在儿科病例中有充分记录，但在成人中仍然罕见。我们报告一例成人神经毒性蝎子蜇伤的罕见病例。
一名32岁有蜜蜂毒液过敏史的西班牙裔女性在被蝎子蜇伤后前往急诊科（ED）。在家中坐着时，她感到右大腿后部被蜇了两下，辨认并打死了蝎子，然后前往急诊科。经评估，患者意识清醒、定向力正常（格拉斯哥昏迷量表评分为15分）。她的生命体征稳定，实验室检查结果无异常。患者最初在蜇伤部位出现局部疼痛，随后出现全身沉重感、肌肉抽搐、口干、舌头“发毛”和喉咙沉重感，但无呼吸窘迫。神经系统检查发现眼球震颤、舌肌束颤和辨距障碍，符合神经毒性中毒表现。她接受了破伤风-白喉-百日咳（Tdap）加强疫苗、生理盐水、昂丹司琼、劳拉西泮和Centruroides蝎子抗毒血清（ANASCORP）治疗。由于她有过敏史，对其进行了密切的过敏反应监测。患者恢复顺利，2天后出院，无神经系统并发症。
蝎子蜇伤可导致严重的神经毒性作用，即使在成人中也是如此，尤其是在多次蜇伤或毒液吸收增强的情况下。早期识别神经毒性症状对于及时使用抗毒血清和支持性治疗至关重要，可显著改善患者预后。本病例强调了即使儿科病例更为常见，也应考虑成人患者神经毒性中毒的重要性。
