Correspondence

Rapidly improving, severe, acute myocarditis after a scorpion bite: an extremely rare complication and successful management

To the Editor,

We thank to Dr Gen-Mib Lin for his/her interest in our case. Actually, we agree with Dr Gen-Mib Lin; however, our Clinical approach paralleled to our clinical facilities. As stated by the author, in the treatment of acute decompensated myocarditis, intraaortic balloon pump, extracorporeal membrane oxygen- ation, and left ventricular assist devices have been used. However, in our pediatrics clinic, such devices have not been provided. That is why the patient was followed medically.

On the other hand, antiserum might have provided such a rapid alleviation. Nevertheless, it is not possible to say which treatment was the most effective one in this case. The medical treatment we made might have provided an alternative for assist devices in such cases.

Yusuf Sezen MD Unal Guntekin MD

Harran University School of Medicine

Department of Cardiology Tip Fakultesi Dekanlik Binasi Kat:3 63300

Sanliurfa, Turkey E-mail address: [email protected]

Hakan Buyukhatipoglu MD Harran University School of Medicine Department of Internal Medicine

Tip Fakultesi Dekanlik Binasi Kat:3 63300

Sanliurfa, Turkey

Zekeriya Kucukdurmaz MD

Sanliurfa Research and Training Hospital

Department of Cardiology

doi:10.1016/j.ajem.2010.10.030

Letter regarding rapidly improving, severe acute myocarditis after a scorpion bite

To the Editor,

We appreciate the experience by Sezen et al [1], who described a 12-year-old boy who developed life-threaten- ing, acute toxic myocarditis and heart failure after a scorpion bite, for whom aggressive medical treatment with inotropic agents, diuretics, and parenteral corticosteroids resulted in rapid clinical resolution. To our knowledge, the natural course of fulminant myocarditis is related to the underlying etiologies including severe ischemia, toxic/ metabolic agents, infection, and inflammation [2]. Select- ing whether to use medical treatment or insertion of a surgical device like intraaortic balloon pump, extracorpo- real membrane oxygenation, and left ventricular assist device is only a bridge for these patients who have a reversible course to recover spontaneously after treatment or for those with an irreversible course to receive cardiac transplantation [3].

For toxic or metabolic myocarditis, time of clinical resolution is directly determined by the binding affinity, metabolism, and elimination of these hazardous agents to the heart. Accordingly, we suspect that the natural course in the patient with scorpion toxic myocarditis was shortened after the administration of antiserum at the first hospital rather than the aggressive medical treatment aimed to maintain his vital signs at the second hospital. As the authors’ discussed, a physiologic response of catecholamines and cytokines levels will surge immedi- ately after scorpion toxin exposure and then drop gradually if the toxin is neutralized, which could account for the rapid natural course of fulminant myocarditis. Therefore, in our opinion, the use of antiserum for scorpion bite should be emphasized, which may be a life- saving step for those developing fulminant myocarditis to shorten its natural course.

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