Abstract

Scorpions are found in six continents of the world. Of the 2000 species, most are not lethal and a sting results in local pain and burning sensation only. On the other hand, a scorpion sting can result in envenomation with systemic toxicity on one hand and an allergic reaction including anaphylaxis on the other hand. Many deaths due to scorpion stings have been reported in literature. The aim of this report is to emphasise that signs and symptoms of envenomation and anaphylaxis might overlap which may result in delayed and improper management with poor treatment outcome including death. We report a child who presented with overlapping clinical picture of anaphylaxis versus envenomation. Within minutes following a scorpion sting on her leg, she developed irritability, excessive crying, vomiting, angioedema of face and a red rash. She was given intramuscular hydrocortisone in local health facility and was referred to our university hospital. On her way to hospital, her condition further deteriorated and developed upper and lower air way obstructive symptoms with drooling of saliva, stridor and respiratory distress and desaturation. On arrival, she was in compensated shock with poor pulses and poor perfusion. She was managed as a case of scorpion sting envenomation and anaphylaxis was not considered initially as one of the possible differential diagnosis. She received anti-venom for scorpion, aggressive fluid resuscitation and respiratory support. She made a slow but complete recovery in the following 24 h. She had a past history of fire ant stings and no previous scorpion sting. Fire ant and scorpion venom are known to cross react. Unfortunately in our centre, facility to test specific Ig E for scorpion venom was not available. Due to symptoms overlap, we suggest that first responders and emergency physicians should consider anaphylaxis as a possible differential when managing envenomation due to scorpion sting.