Iranian Journal of Pathology

Hemolytic Uremic Syndrome Secondary to Scorpion Envenomation in a 7-Year-Old Boy from Southwestern Iran

Document Type : Case Reports

Authors

Nafiseh Mortazavi 1
Nakisa Hooman 2
Mitra Mehrazma 3
Yasaman Moradi 4
Parvin Aghavali 4

1 Aliasghar Clinical Research Development Center, Department of Pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Hasheminejad Kidney Center, Department of pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Department of Pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30699/ijp.2024.2024403.3272
Abstract
Hemiscorpius lepturus is a deadly scorpion species found in the tropical regions of the Middle East. Its venom consists of a complex mixture of peptides and enzymes, including the protease toxin hemiscorpius crolysin, the analgesic peptide, and the cytotoxic agent which attacks vascular low-body weight patients, and especially young patients, are prone to systemic complications such as nephrotoxicity, hemolysis, hepatotoxicity, and even death.
In this case report, we present a 7-year-old boy from city of Ahwaz in southwestern Iran, who was bitten by Gadeem (H. lepturus) and developed hemolytic uremic syndrome. After being stung, the patient developed hemolytic anemia, thrombocytopenia, and uremia in the subsequent days. The patient received supportive treatment, hemodialysis, and plasma exchange, and was discharged after 30 days of hospitalization.

Keywords

Hemolytic anemia
tubular injury
thrombotic microangiopathy

Subjects

  1. Valavi E, Amuri P, Ahmadzadeh A, Cheraghian B, Ahankoob E. Acute kidney injury in Hemiscorpius lepturus scorpion stung children: Risk factors and clinical features. Saudi J Kidney Dis Transpl. 2016;27(5):936-41. [DOI:10.4103/1319-2442.190841] [PMID]
  2. Shahi M, Moosavy SH, Sanaei-Zadeh H. Severe hemoglobinuria due to Hemiscorpius enischnochela (Scorpiones: Hemiscorpiidae) envenomation from South of Iran. Journal of Emergency Practice and Trauma. 2020;6(2):121-5. [DOI:10.34172/jept.2020.22]
  3. Bagheri-Ziari S, Shahbazzadeh D, Sardari S, Sabatier JM, Pooshang Bagheri K. Discovery of a New Analgesic Peptide, Leptucin, from the Iranian Scorpion, Hemiscorpius lepturus. Molecules. 2021;26(9):2580. [DOI:10.3390/molecules26092580] [PMID] [PMCID]
  4. Valavi E, Ansari MJ, Hoseini S. ADAMTS-13 deficiency following Hemiscorpius lepturus scorpion sting. Saudi J Kidney Dis Transpl. 2011;22(4):792-5.
  5. Canpolat N. Hemolytic uremic syndrome. Turk Pediatri Ars. 2015;50(2):73-82. [DOI:10.5152/tpa.2015.2297] [PMID] [PMCID]
  6. Szarvas N, Szilagyi A, Tasic V, Nushi-Stavileci V, Sofijanova A, Gucev Z, et al. First-line therapy in atypical hemolytic uremic syndrome: consideration on infants with a poor prognosis. Ital J Pediatr. 2014;40:101. [DOI:10.1186/s13052-014-0101-7] [PMID] [PMCID]
  7. Raina R, Vijayvargiya N, Khooblall A, Melachuri M, Deshpande S, Sharma D, et al. Pediatric Atypical Hemolytic Uremic Syndrome Advances. Cells. 2021;10(12):3580. [DOI:10.3390/cells10123580] [PMID]
  8. Lee H, Kang E, Kang HG, Kim YH, Kim JS, Kim H-J, et al. Consensus regarding diagnosis and management of atypical hemolytic uremic syndrome. The Korean Journal of Internal Medicine. 2020;35(1):25. [DOI:10.3904/kjim.2019.388] [PMID] [PMCID]
  9. Dehghani R, Kamiabi F, Mohammadi M. Scorpionism by Hemiscorpius spp. in Iran: a review. J Venom Anim Toxins Incl Trop Dis. 2018;24:8. [DOI:10.1186/s40409-018-0145-z] [PMID] [PMCID]
  10. Dehghani R, Djadid ND, Shahbazzadeh D, Bigdelli S. Introducing Compsobuthus matthiesseni (Birula, 1905) scorpion as one of the major stinging scorpions in Khuzestan, Iran. Toxicon. 2009;54(3):272-5. [DOI:10.1016/j.toxicon.2009.04.011] [PMID]
  11. Shahi M, Sanaei-Zadeh H. The First Report of the Dangerous Scorpion Hemiscorpius acanthocercus from Hormoz Island in the Persian Gulf. Journal of Arthropod-Borne Diseases. 2022. [DOI:10.18502/jad.v15i3.9822] [PMID] [PMCID]
  12. Soleimani Moez A, H. Sajedi R, Pooshang Bagheri K, Sabatier J-M, Shahbazzadeh D. Novel mutant Phospholipase D from Hemiscorpius lepturus acts as a highly immunogen in BALB/c mice against the lethality of scorpion venom. Molecules. 2020;25(7): 1673. [DOI:10.3390/molecules25071673] [PMID] [PMCID]
  13. Shahbazzadeh D, Srairi-Abid N, Feng W, Ram N, Borchani L, Ronjat M, et al. Hemicalcin, a new toxin from the Iranian scorpion Hemiscorpius lepturus which is active on ryanodine-sensitive Ca2+ channels. Biochemical journal. 2007;404(1):89-96. [DOI:10.1042/BJ20061404] [PMID] [PMCID]
  14. Benz K, Amann K. Thrombotic microangiopathy: new insights. Curr Opin Nephrol Hypertens. 2010;19(3): 242-7. [DOI:10.1097/MNH.0b013e3283378f25] [PMID]
  15. Yuksel S, Isik Gonul I, Canpolat N, Gokce I, Ozlu SG, Ozcakar ZB, et al. Renal Biopsy Prognostic Findings in Children With Atypical Hemolytic Uremic Syndrome. Pediatr Dev Pathol. 2020;23(5):362-71. [DOI:10.1177/1093526620925947] [PMID]
  16. Montemurro NE, Di Maggio A, Strippoli P, Coviello F, Godino F, Miloro G, et al. Combined dialysis and plasma-exchange in acute renal failure. Biomater Artif Cells Immobilization Biotechnol. 1993;21(2):283-7. [DOI:10.3109/10731199309117364] [PMID]
Iranian Journal of Pathology
Volume 19, Issue 4
Autumn 2024
Pages 467-471

  • Receive Date 16 March 2024
  • Revise Date 20 June 2024
  • Accept Date 26 May 2024

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