Muhammed Enes TAYSI, Mustafa Enes DEMIREL
Experimental and Applied Medical Science - 2026;7(2):173-182
Background: Scorpion stings are generally associated with local symptoms; however, systemic toxicity, including clinically significant cardiac involvement, may occur. This case report aims to highlight the possibility of cardiotoxicity following a scorpion sting in an elderly patient despite limited systemic manifestations at presentation. Case Presentation: An 84-year-old woman with a history of hypertension presented to the emergency department (ED) after a scorpion sting to the left great toe. Her primary complaint was localized pain, and her vital signs were stable on admission. During ED observation, cold diaphoresis developed, and serial high-sensitivity cardiac troponin T (hs-cTnT) measurements showed a marked increase from 24 ng/L to 261 ng/L and subsequently to 318 ng/L. The initial electrocardiogram (ECG) demonstrated T-wave inversion in V2 and the lateral precordial leads (V5-V6), without dynamic ischemic changes on repeat recordings. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction of 35% with mild aortic, tricuspid, and mitral regurgitation. Considering suspected scorpion venom-associated cardiotoxicity, scorpion antivenom was administered intravenously as a slow infusion, and the patient was admitted to the coronary intensive care unit (CICU) for close monitoring. Coronary angiography was recommended; however, the patient refused the procedure and further in-hospital evaluation and treatment. Therefore, acute coronary syndrome could not be fully excluded. At subsequent clinical follow-up, the patient reported no complaints, and repeat cardiac enzyme testing was not suggestive of ongoing myocardial injury. Conclusion: Clinically significant cardiac involvement may develop after a scorpion sting even in an elderly patient with an initially mild presentation and stable vital signs. Serial ECG assessment, repeated cardiac biomarker measurements, timely cardiology consultation, and close clinical observation should be considered when cardiotoxicity is suspected.
