Scorpion Sting-Associated Cardiotoxicity in an Elderly Patient: A Case Report and Brief Clinical Discussion

Scorpion stings are generally associated with local symptoms, but they may also cause systemic toxicity, including clinically significant cardiac involvement. We report an 84-year-old woman with a history of hypertension who presented to the emergency department (ED) after a scorpion sting to the left great toe. Her initial complaint was localized pain, and vital signs were stable on admission. Subsequent evaluation demonstrated elevated high-sensitivity cardiac troponin T (hs-cTnT) levels. The initial electrocardiogram (ECG) showed T-wave inversion in V2 and the lateral precordial leads (V5-V6), without dynamic changes on repeat recordings. Transthoracic echocardiography (TTE) showed a left ventricular ejection fraction of 35%, with mild aortic, tricuspid, and mitral regurgitation. Myocardial injury or cardiotoxicity due to scorpion venom was suspected, and one vial (1 mL) of scorpion antivenom was administered intravenously as a slow infusion over 30 minutes in the ED. The patient was admitted to the coronary intensive care unit (CICU), and coronary angiography was recommended; however, she declined the procedure and further in-hospital evaluation and treatment. Acute coronary syndrome could not be fully excluded. She left the hospital voluntarily after informed refusal was documented. At subsequent clinical follow-up, the patient reported no complaints, and repeat cardiac enzyme testing was not suggestive of ongoing myocardial injury. This case highlights that scorpion sting-associated cardiotoxicity can occur in older adults despite minimal systemic manifestations, underscoring the importance of serial ECG, cardiac biomarker monitoring, cardiology consultation, and close observation.