Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2014; 18: 1419-1421 Chronic Mesobuthus gibbosus scorpionism related to the sting in vein B. PAJOVIC, N. RADOJEVIC 1, M. RADOSAVLJEVIC 2 Faculty of Medicine, University of Montenegro, Urology and Nephrology Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro 1Department of Forensic Medicine, Faculty of Medicine, University of Montenegro, Clinical Centre of Montenegro, Podgorica, Montenegro 2Department of Surgery, Public Hospital Kotor, Podgorica, Montenegro Abstract. – BACKGROUND: A small amount thin pliers, the most poisonous in Europe (Fig - of data is already presented in the relevant liter - ure 1). It can reach up to 85 mm. It is exclusive - ature related to the medical facts of scorpi - ly night-time animal, feeds on insects. Dry and onism caused by Yellow scorpion (Mesobuthus gibbosus: M. gibbosus) . Undoubtedly, it is con - hot areas with sparse vegetation are preferred sidered as dangerous to human health. This pa - habitats, like olive groves and beaches. During per presents an unusual case of scorpionism the day, it is hiding under the rocks or other ob - after the sting in vein. jects on the ground 2. Hibernate runs from Sep - CASE REPORT: A 25 year old male was bitten tember till May 4,5 . by M. gibbosus. He experienced extremely se - Its poison is neurotoxic, as all poisons of vere intermittent pain in the right feet, followed Buthidae family representatives. In relevant med - by pulsating and glowing sensations, cold sweat and paleness. 15 minutes after the sting, ical literature, its poison is described as a very 6-9 the pain started to spread through the medial dangerous to human health . This kind of scorpi - side of the leg, up to the inguinal region. Pa - onism is a significant medical problem in Turkey. tient became excited, and experienced occa - Ozkan et al 10 reported a few children deaths. sional spasms of leg muscles. A month after, the bitten vein of dorsal arch of the foot and v. sephena magna became non-uniformly tortu - ously spread through the entire length. On Case Report physical examination four years after the sting, the enlargement of the veins still exists, period - A 25 year old student, 180 cm height, 110 kg ical tingling, and occasional muscle twitches weight, was stung by M. gibbosus in June 2008. during the night. Suddenly, he experienced extremely severe in - CONCLUSIONS: M. gibbosus is endemic in termittent pain in the right feet. Patient de - Mediterranean area and represents a real haz - scribed the pain stronger than a sting of an an - ard for local inhabitants and tourists. The med - ical treatment of this type of scorpionism is ex - gry hornet (Vespa crabro Linné) , which had sus - clusively symptomatic. tained two years ago. He was very descriptive: “as someone burns his skin with cigarette- Key Words: lighter”. The pain became pulsating , very high Yellow scorpion, Mesobuthus gibbosus, Buthidae, in intensity, and glowing at the bite site. After a Scorpionism, Chronic scorpionism, Phlebitis. few minutes , a cold sweat covered his body, ac - companied with generalizated palor. Around the injured site, the skin was blue , and that discol - Introduction oration lasted for 45 minutes. 15 minutes after the sting, the pain started to spread through the Yellow scorpion (Mesobuthus gibbosus , Brul - medial side of the leg, up to the inguinal region. lé 1832 ) lives in Mediterranean region of Eu - 45 minutes after, the pain slightly weakened and rope (Italy, Croatia, Montenegro, Albania, localized from the feet to the mid of lower leg. Greece, Cyprus, Turkey, etc) but is found in In first few hours , he became excited, and ex - Bulgaria, Syria and Lebanon 1-3 . It is a very ag - perienced occasional spasms of leg muscles. In gressive yellow or yellow-brown scorpion with Emergency Service, chlorpiramin hydrochloride Corresponding Author: Radojevic, Nemanja, MD, MSc; e-mail: [email protected] 1419 B. Pajovic, N. Radojevic, M. Radosavljevic able burning and tingling sensation along the al - tered veins, while during the sleep the injured leg unconsciously twitched sometimes . Superficial veins of the left leg are normal . He denied famil - iar varices cruris. Doppler ultrasonography did not reveal thrombosis, but the thickening of vein wall was present. On phyisical examination four years after the bite, the enlargement of the veins still exists , pe - riodical tingling, and occasional muscle twitches duging the night . Oedema of the leg was rare and slight. Figure 1. M. gibbosus . Photo by Jan Ove Rein, The scorpi - Discussion on Files. See Acknowledgement paragraph. Scorpionism caused by Buthida family mem - bers, which includes M. gibbosus , is character - 20 mg/2 mL , methylprednisolone 80 mg/2 mL , ized by local and general symptoms. From local, antitetanus vaccine 40 UI /0.5 ml with antitetanus the most common are pain at the stung site which immunoglobulin 250 UI /2 ml, and diclofenac 75 becomes pale or blue, accompanied with hyper - mg/3 mL were administrated (all intramuscular - estesia . General symptoms include varieties of ly), and 500 mL of 5% glucose solution intra - neurological, cardiovascular and genitourinary venously. disorders 11 . At hospital, laboratory parameters of blood According to the recent statistics from Turkey and urine were in normal range, ECG and on a large sample, the scorpion stings occur usu - blood-pressure, too. Surgical evaluation re - ally in June, July and August, and only sporadi - vealed the sting site on the skin just above the cally in May and September. The women are vein which belonged to the dorsal venous arch usually injured ones (60%). Younger population of the foot. Palpation of the injured region pro - is mostly affected ( 15 to 29 year old), followed voked the attack of stronger pain. During the by the age of 0 to 14. The injection site is usually hospital treatment, the tingling was constant, the upper and lower limbs 9. while the pain oscillated in intensity, and was Local symptoms caused by the sting of scorpi - depended on analgetics. The useness of single on M. gibbosus and other Mesobuthus (M. eu - dose of analgesic lasted only one hour. About peusa, M. caucasicus, M. nigrocinctusa) are 10 hours after the sting, he experienced a very pain, hyperemia, swelling, feeling of burning at hard cramp in the region of tibialis anterior the injured site, paresthesia , and itching 9,10 . Gen - muscle. Intramuscularly diazepam ( 10 mg/2 eral symptoms that occur with this scorpionism mL) , double dose of diclofenac (75 mg/3 mL), include dry mouth, thirst, sweating, nausea, dys - and two doses of metamizol (2.5 g /5 mL) were pnea, cyanosis, increased bronchial secretions, administrated, followed by two doses of calci - tachypnea, hypotension, hypertension, tachycar - um-glubionate (1 .375 g /10 mL), and two doses dia, bradycardia, arrhythmias, muscle contrac - of Ringer solution (500 mL), intravenously . tions, convulsions, pulmonary edema, shock and On second day, the tingling was the dominated eventually death due to cardiorespiratory insuffi - symptom in the foot . The laboratory findings re - ciency 9- 12 . vealed slightly increased leukocytes (13.4 g/L), The patient from the case under review here, hyperglycemia (8. 5 mmol/L) , increased creati - experienced an extremely strong, searing pain, nine (116 µmol/L ) with proteinuria. On third day, he sweated copiously throughout the body, be - all parameters returned to normal ranges. came pale, with muscle cramps, and excited. A month after , the sting vein of dorsal arch of Excitation that accompanies the scorpionism is the foot and saphena magna vein became non- associated with a particular peptide in the ven - uniformly tortously spread through the entire om with a specific MAO-A inhibitor effect 13 . length. It was more apparent after the long stand - Affecting the magistral vein, the scorpionism ing. In addition, he occasionally felt uncomfort - turned to the chronicity, and seems to be com - 1420 Chronic Mesobuthus gibbosus scorpionism related to the sting in vein pletely unusual presentation. Post-sting References phlebitis was observed, four years lately still without thrombosis. 1) FET V, B RAUNWALDER ME. T he scorpions (Arachnida: From the experience of the Authors of the Scorpiones) of the Aegean area: current prob - lems in taxonomy and biogeography. Belg J Zool paper, three other patients who sustained M. 2000; 130(suppl): 17-22. gibbosus stings were noticed in recent years. 2) REIN JO. A review of the scorpion fauna of Europe. The injured sites were lumbal region, big toe, Medical Library & Information Center, Norwegian and anterior femoral just above the knee. All of University of Science and Technology. 2013 February them referred local paresthesia around the site, [cited 2013 Mar 04] Available from: http://www.ntnu.no/ub/scorpion- strong searing pain, numbness, tingling, oede - files/european_scorp.php ma and erythema of the surrounding skin. 3) KALTSAS D, S TATHI I, F ET V. Scorpions of the eastern Symptomatic therapy was administrated in Mediterranean. In: Makarov SE, Dimitrijevic RN, every case. In one of them, numbness lasted for Eds. Advances in Arachnology and Developmen - a month. Comparing the size of the scorpions tal Biology, Papers dedicated to Prof. Dr. Bozidar Curcic. 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