Akrep ve örümcek sokmasına bağlı gelişen geçici miyokardit ve kardiyomiyopati
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Date
2011-03-23
Authors
Kır, Mustafa
Karadaş, Ulaş
Yılmaz, Nuh
Saylam, Gül Sağın
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Giriş: Örümcek ve akrep sokmaları, ısırılma yerine ait lokal reaksiyonlardan, ölüme yol açacak çoklu organ tutulumlarına kadar geniş bir yelpazede klinik bulgulara neden olur. Çocukların vücut kitlelerinin az olması nedeniyle ısırılma sonrası önemli organ tutulumlarının görülmesi daha sık görülür. Isırılma sonucu hayatı tehdit eden en önemli organ tutulumu kalp ve akciğerlerde görülür. Bu makalede akrep ve örümcek sokmasına bağlı miyokardit ve kardiyomiyopati gelişen iki olgu sunulmuştur. Olgu sunumu: On yaşında bir erkek hastanın sağ elini bir örümceğin sokmasını takiben gelişen solunum zorluğu ve taşikardisi nedeniyle yapılan değerlendirmede kalp kası enzimleri yüksek bulundu [CK-MB: 16,5 ng/ml (N:0,0-7,2 ng/ml), troponin: 3,06 ng/ml (N:0,0- 0,3ng/ml)] EKG’de V3 ve V4’de patolojik ST elevasyonları ve V5,V6’da T negatiflikleri görüldü. EKO’da sol ventrikül dilatasyonu ve orta derecede sistolik fonksiyon bozukluğu saptandı. Antivenom [Serum antiscorpionique (labs 50)®] yapıldı (5 cc antivenom 1/10 oranında serum fizyolojik ile sulandırıldıktan sonra intravenöz olarak yapıldı). Destekleyici tedavi ile 1 hafta içinde olgunun tüm patolojik bulguları normale döndü. İkinci olgu 8 yaşında erkek hasta sağ ayaktan akrep sokmasını takiben solunum zorluğu ve konvülziyon geçirmesi üzerine merkezimizde yoğun bakım koşullarında izleme alındı. Troponin ve CK-MB düzeylerinde artış saptanan, EKG’de patolojik ST depresyonları görülen ve EKO’da sol ventrikül dilatasyonu ve sistolik fonksiyon bozukluğu saptanan hastaya iki kez antivenom uygulandı. Dobutamin tedavisi ile destek tedavilere cevap veren olgunun 10. günde tüm bulguları geriledi. Tartışma: Akrep veya örümcek sokmaları sonucunda gelişen miyokardit sol ventrikül sistolik fonksiyon bozukluğu yaparak hayatı tehdit edebilir. Bu tutulumdan artmış katekolaminerjik aktivite veya direkt toksinin miyokard fibrilleri üzerine olan etkisi sorumlu tutulmaktadır. Isırığa maruz kalmış olgularda kalp tutulumunun değerlendirilmesi için EKG çekilmeli, kalp kası enzimleri monitörize edilmeli ve EKO yapılmalıdır. Ciddi olguların solunum ve dolaşım sistemlerinin yakın takibi için yoğun bakım şartlarında izlenmesi gereklidir.
Introduction: Spider and scorpion stings can cause multiple clinical manifestations such as local skin reactions or multiple organ failure that can cause death. Multi-organ involvement is more frequent in children due to their lower body weight. The most important life threatening event after the sting is cardiac and lung involvement. In this case report, two cases who developed myocarditis and cardiomyopathy following scorpion and spider stings were reported. Case Report: Clinical evaluation of a ten-year-old boy with respiratory distress and tachycardia after being bitten by a spider on his right hand revealed high levels of cardiac enzymes [CK-MB: 16.5 ng/ml (N:0.0-7.2 ng/ml), troponin: 3.06 ng/ml (N:0.0-0.3ng/ml)], pathological ST elevations in leads V3 and V4, and T wave negativity in leads V5 and V6. In echocardiography, left ventricular dilatation and moderate systolic dysfunction were found. Antivenom [Serum antiscorpionique (labs 50)] was given (5 cc antivenom was administered intravenously following a 1:10 dilution with normal saline). With supportive treatment, all pathological findings resolved in a week. The second case was an eight-year-old boy who had been bitten by a scorpion on his foot and taken to the intensive care unit because of respiratory distress and convulsion. Two doses of antivenom were given to the case who had elevated levels of troponin and CK-MB, pathological ST depressions in ECG, and left ventricular dilatation and systolic dysfunction, as revealed by echocardiography. With dobutamin and supportive treatment, the pathological findings normalized in ten days. Conclusion: Myocarditis developing following spider or scorpion bites can threaten life due to left ventricular systolic dysfunction. This consequence has been attributed to increased catecholaminergic activity or direct effect of toxin to myocardial fibres. ECG must be performed, cardiac enzymes must be monitored and echocardiography must be done to evaluate cardiac involvement in cases suffering from such bites. Severe cases must be taken to the intensive care unit in order to monitor respiratory and circulatory systems.
Introduction: Spider and scorpion stings can cause multiple clinical manifestations such as local skin reactions or multiple organ failure that can cause death. Multi-organ involvement is more frequent in children due to their lower body weight. The most important life threatening event after the sting is cardiac and lung involvement. In this case report, two cases who developed myocarditis and cardiomyopathy following scorpion and spider stings were reported. Case Report: Clinical evaluation of a ten-year-old boy with respiratory distress and tachycardia after being bitten by a spider on his right hand revealed high levels of cardiac enzymes [CK-MB: 16.5 ng/ml (N:0.0-7.2 ng/ml), troponin: 3.06 ng/ml (N:0.0-0.3ng/ml)], pathological ST elevations in leads V3 and V4, and T wave negativity in leads V5 and V6. In echocardiography, left ventricular dilatation and moderate systolic dysfunction were found. Antivenom [Serum antiscorpionique (labs 50)] was given (5 cc antivenom was administered intravenously following a 1:10 dilution with normal saline). With supportive treatment, all pathological findings resolved in a week. The second case was an eight-year-old boy who had been bitten by a scorpion on his foot and taken to the intensive care unit because of respiratory distress and convulsion. Two doses of antivenom were given to the case who had elevated levels of troponin and CK-MB, pathological ST depressions in ECG, and left ventricular dilatation and systolic dysfunction, as revealed by echocardiography. With dobutamin and supportive treatment, the pathological findings normalized in ten days. Conclusion: Myocarditis developing following spider or scorpion bites can threaten life due to left ventricular systolic dysfunction. This consequence has been attributed to increased catecholaminergic activity or direct effect of toxin to myocardial fibres. ECG must be performed, cardiac enzymes must be monitored and echocardiography must be done to evaluate cardiac involvement in cases suffering from such bites. Severe cases must be taken to the intensive care unit in order to monitor respiratory and circulatory systems.
Description
Keywords
Akrep sokması, Miyokardit, Çocuk, Scorpion envenomation, Myocarditis, Children
Citation
Kır, M. vd. (2011). "Akrep ve örümcek sokmasına bağlı gelişen geçici miyokardit ve kardiyomiyopati". Güncel Pediatri, 9(2), 100-102.