Fatal scorpionic myocarditis: Interest of circulatory assistance (ECMO)

Introduction Scorpion envenomation represents a real public health problem, especially during the summer period in the countries of North Africa. It is characterized by a large clinical polymorphism ranging from the simple local pain to the point of sting at a cardiovascular collapse resulting. A small number of patients will present with cardiogenic shock unresponsive to standard medical therapy. Method We report 5 patients with scorpion myocarditis, who were hospitalised in Intensive Care Unit and received ECMO adjuvant therapy from February 2014 to August 2018, were analysed. Results The median age was 25 years (range 11–39 years). Common symptoms at diagnosis included local pain (100%), chest pain (60%), shortness of breath (100%). Electrocardiograpy revealed dysrhythmia in 1 patient (VT), T-wave inversion and ST depression in the inferolateral in 3 patients and in anterior leads in 1 patient. Echocardiography demonstrated in all patients severe global hypokinesia of both right and left ventricles with elevated filling pressures and mid mitral regurgitation and left ventricle ejection fraction less than 35%. The diagnosis of cardiogenic shock with pulmonary edema was made for all patients. Because of severe presentation and worsened hemodynamic status despite raising dobutamine doses (20 γ/kg/min) and adrenaline (0,3 γ/kg/min) adjunction, we decided to initiate cardiopulmonary support by ECMO. The five patients were successfully weaned from ECMO treatment. The total survival rate was 100%. Although myocardial damage and dysfunction were severe During the follow-up period, cardiac function recovered normally in the 5 surviving patients after a period of 1 month. Conclusion The severity of scorpion envenomation results mainly from left cardiac dysfunction with pulmonary edema and/or shock. Adrenergic myocarditis, toxic myocarditis and myocardial ischemia are the main mechanisms.