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Adriano Scaff Garcia Danielo Garcia de Freitas Osvaldo de Freitas Filho
Case R eport
INTRODUCTION
In Brazil 4 0 0 0 sco rpio n sting s are repo rted every year.1 At o ur teaching ho spital we see 6 0 c a se s p e r ye a r. Tw o sc o rp io n sp e c ie s a re respo nsible fo r mo st o f the repo rted cases: Tytius serrulatus and T. bahiensis. A third species, T. trivitta tus (Fig . 1 ), is c o nsid e re d the mo st dang ero us but is rarely o bserved. The majo rity o f sc o rp io n sting s a re o lig o symp to ma tic , o ccurring mainly o n the hands and feet. Fatality
Pe nis wound by scorpion sting
Centro de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
ABSTRACT
Contex t: The majo rity o f sco rpio n sting s are
o lig o sympto matic, o ccurring mainly o n the hands and feet. Fatality is rare.
Ca se report: A 3 3 -year o ld man suffered a severe sting o n his penis fro m a sco rpio n o f the species Tytius trivittatus. Alco ho l and salt were used witho ut success in an effo rt to relieve pain. Medical assistance was so ug ht 4 ho urs after the event, at which time diffuse erythema, edema and punctifo rm injury o n the g lans penis were o bserved, with no systemic manifestatio n. Intraveno us meperidine was administered with immediate relief o f the pain. The lo cal sig ns disappeared within 4 8 ho urs, with the patient remaining asympto matic.
Key W ords: Sco rpio n sting . Penis.
Figure 1 - Titius Trivittatus.
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is rare. W e repo rt here a rare case o f a sco rpio n sting o n the penis.
CASE REPORT
A 3 3 -year o ld man suffered a severe sting o n his penis fro m a sco rpio n o f the species Tytius trivittatus. Alco ho l and salt were used witho ut suc c ess in a n effo rt to relieve pa in. Medic a l assistance was so ug ht 4 ho urs after the event, at w hic h time d iffuse e rythe ma , e d e ma a nd p unc tifo rm injury o n the g la ns p e nis w e re o b se rve d , w ith no syste mic ma nife sta tio n. Intraveno us meperidine was administered with immedia te relief o f the pa in. The lo c a l sig ns disappeared within 4 8 ho urs, with the patient remaining asympto matic.
DISCUSSION
The classical clinical picture o f sco rpio n sting s is characteriz ed by lo cal pain, which may extend to reg io nal lymph no des, hyperemia and edema.2 Systemic manifestatio ns are rare and inc lud e c a rd ia c a nd kid ne y le sio ns, mo re c o mmo nly in c hild re n a nd o ld p e o p le . Hypertensio n, hypo thermia, cardiac arrhythmia and pulmo nary edema may o ccur. Ho wever, the wo rldwide fatality rate is less than 1 %.2 ,3 There are o nly two repo rted cases o f sting s o n unusual areas o f the bo dy: o ne o n the face4 and o ne o n the penis,5 bo th by T. serrulatus.
Except fo r the unusual site o f the sting , o ur p a tie nt p re se nte d a c linic a l p ic ture o f mild intensity. Self-administratio n o f alco ho l and salt may have co ntributed to aug menting the pain. A sting o n the penis sho uld be treated like sting s o n any o ther part o f the bo dy. Lo cal analg esic blo ck with 1 % lido caine fo r pain relief is usually
RESUMO
Contex to: A maio ria das ferro adas de esco rpião são o lig o ssinto máticas, o co rrendo nas mão s e no s pés. Fatalidade é rara.
Rela to de Ca so: Descreve-se caso raro de ferro ada de esco rpião da espécie Tytius trivittatus em pênis de um ho mem de 3 3 ano s. O paciente pro curo u o ho spital 4 ho ras apó s, queixando -se de intensa do r no lo cal. Meperidina endo veno sa fo i administrada co m reso lução do quadro do lo ro so imediatamente. O paciente evo luiu sem co mplicaçõ es sistêmicas, co m o s sinais lo cais desaparecendo em 4 8 ho ras.
re so rte d to . Fo r tho se c a se s o f sy ste mic manifestatio n a specific antivenin is indicated. Treatment o f hypertensio n and acute pulmo nary edema has been successfully repo rted with the use o f praz o sin. In o ur case repo rt the sco rpio n was the T. trivittatus species, and no systemic ma nifesta tio ns were o b served. The c ho ic e o f the ra p y w a s intra ve no us a na lg e sic w ith me p e rid ine 5 0 mg sing le d o se , fo llo w e d b y ing estio n o f pyro xicam fo r a perio d o f three days fo r maintenance. There was no need fo r lo cal blo ck with anesthetics.
Sao Paulo Med J/Rev Paul Med 1999; 117(2):85-6
REFERENCES
1. Brazil. Ministério da Saúde/FNS/CENEPI: Info rme Epidemio ló gico do SUS 1992;1:20.
2. Bucherl W. Veno ms o f Tityinae. A: Systematics, distributio n, bio l-o gy, venl-o ml-o us apparatus, etc. l-o f Tityinae: venl-o m cl-o llectil-o n, tl-o xic-ity, human accidents and treatment o f sting. In: Bettini S. (Ed) Hand-bo o k o f Experimental Pharmaco lo gy, vo l. 48: Arthro po d Veno ms. New Yo rk: Springer-Verlag 1978;ch.14:371-9.
3. Cardo so JLC, Brando RB. Acidentes po r Animais peço nhento s. São Paulo : Livraria Edito ra Santo s; 1982.
4. Nishio ka SA, Silveira PVP, Ugrino vich R, De Oliveira RB. Sco rpio n sting with cranial nerve invo lvement: letter. To xico n 1992;30:685. 5. Nishio ka SA, Silveira PVP, Pereira CAD. Sco rpio n sting o n the penis:
case repo rt. J Uro l 1993;150:1501.
Adria no Sca ff Ga rcia - Residente de N euro cirurg ia, Ho spital das Clínicas da Faculdade de Medicina de Ribeirão Preto
Da nielo Ga rcia de Freita s - Pó s-g raduando de Uro lo g ia da UN IFESP-EPM
O sva ldo de Freita s Filho - Do cente de Uro lo g ia da Universidade Federal de Uberlândia
Sources of Funding: N o t declared
Conflict of interest: N o t declared
La st received: 3 Aug ust 1 9 9 8
Accepted: 1 1 September 1 9 9 8
Address for correspondence:
Adriano Scaff G arcia
