Clinical Characteristics and Outcomes of Kounis Syndrome Following Scorpion Envenomation

Introduction Scorpion sting-induced Kounis syndrome (Ks) is a rare and underrecognized form of allergic acute coronary syndrome. Although scorpion envenomation is a significant cause of morbidity in endemic regions, its association with Ks has been infrequently reported. This study aimed to describe the clinical characteristics, management, and outcomes of venom-induced Ks. Methods Following institutional ethical approval, medical records of 175 patients admitted with scorpion envenomation between January 2014 and March 2024 were retrospectively reviewed. Of these patients, 34 met predefined inclusion criteria. Demographic data, clinical features, cardiac investigations, treatments, intensive care unit course, and short-term outcomes were analyzed. Group comparisons and odds ratios with 95% confidence intervals were calculated using appropriate statistical methods. Results The cohort comprised 21 children and 13 adults, with a median age of 9 y (interquartile range 4–52). Chest pain (88.2%) and generalized erythema or urticaria (94.1%) were the most frequent presenting features. Pediatric patients exhibited significantly higher rates of cardiac involvement, including left ventricular ejection fraction reduction, hyperlactatemia, clinical need for prazosin, and need for inotropic support. Severe cardiac involvement occurred more frequently in children than in adults (90 vs 23%; odds ratio 31.7, 95% CI 4.52–221.73, P <0.001). Coronary angiography, performed selectively, revealed no significant obstructive lesions in most patients. No 30-d mortality was observed. Conclusions Pediatric patients demonstrated a more severe pattern of cardiac involvement than adults, suggesting an age-dependent clinical phenotype following scorpion envenomation. Given the limited sample size, these findings should be interpreted with caution and warrant validation in larger multicenter cohorts.